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The lived experience of an eating disorder among gifted female adolescents : a phenomenological study Bell, Alison J. 2004

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T H E L I V E D E X P E R I E N C E O F A N E A T I N G D I S O R D E R A M O N G G I F T E D F E M A L E A D O L E S C E N T S : A P H E N O M E N O L O G I C A L S T U D Y by A L I S O N J . B E L L B . A . , S i m o n Fraser Un ive r s i ty , 2G01 A T H E S I S S U B M I T T E D I N P A R T I A L F U L F I L M E N T O F T H E R E Q U I R E M E N T S F O R T H E D E G R E E O F M A S T E R O F A R T S i n T H E F A C U L T Y O F G R A D U A T E S T U D I E S (Department o f Educa t iona l and Counse l l i ng Psycho logy , and Spec ia l Educa t ion) W e accept this thesis as conforming to the required standard T H E U N I V E R S I T Y O F B R I T I S H C O L U M B I A A p r i l 2004 © Alison J. Bell (2004) Library Authorization In presenting this thesis in partial fulfillment of the requirements for an advanced degree at the University of British Columbia, I agree that the Library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the head of my department or by his or her representatives. It is understood that copying or publication of this thesis for financial gain shall not be allowed without my written permission. Alison J.Bell 19/04/2004 Name of Author (please print) Date (dd/mm/yyyy) Title of Thesis: The Lived Experience of an Eating Disorder Among Gifted Female Adolescents: A Phenomenological Study Degree: Master of Arts Year: 2004 Department of Counselling Psychology The University of British Columbia Vancouver, BC Canada Library Authorization In presenting this thesis in partial fulfillment of the requirements for an advanced degree at the University of British Columbia, I agree that the Library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the head of my department or by his or her representatives. It is understood that copying or publication of this thesis for financial gain shall not be allowed without my written permission. * Name of Author (please print) Date'(dd/mrr/yyyy) Title of Thesis: 7 ^ ) r S L / \fecL £ x DtLf le-HOP of An Erodhint A Fheoom-ervoleJ^'t Ccx\ S^rnck^ Degree: H | f t S ^ e r o £ A v ^ t S ^ Y e a r : c2QOlj Department of fLoo^SeJ 1 1 n * \ fe^ChO'lcaM The University of British Columbia J <J Vancouver, BC Canada A B S T R A C T A l t h o u g h several recognized experts have a l luded to eating disorders among gifted adolescents as an important topic, it has not been explored through r igorous research methodology. Descr ip t ive phenomenologica l methodology was used to p rov ide an in-depth descr ipt ion o f the experience, core themes, and meaning o f disordered eating among gifted female adolescents (ages 15-18). The research data were gained through in-depth in terviews w i t h s ix participants. A situated structure, based on the predominant themes for each i nd iv idua l participant, and an in-depth descript ion o f the core and c o m m o n themes o f a l l the part icipants ' experiences o f their eating disorders, were developed. These core and c o m m o n themes were organized into themes and sub-themes, each elaborated on and supported through th ick descr ipt ion, in terview excerpts, and the words o f the participants themselves. T h e phenomenologica l descript ion o f the themes p rov ided in-depth explora t ion o f areas p rev ious ly addressed i n the relevant literature such as perfect ionism, contro l , and l o w self-esteem. Themes that address the profound negative affective response, exp l i c i t connect ion o f giftedness to psycholog ica l distress, identity issues, emot iona l restr ict ion, awareness o f mult i faceted under ly ing factors, a de-emphasis on weight and thinness, and a sense o f purpose and meaning i n the eating disorder experience represent o r ig ina l research contributions that extend the current state o f knowledge . T h e p rev ious ly unexplored themes, and r ich descr ipt ion o f the l i v e d experience o f an eating disorder among gifted adolescents s ignif icant ly contribute to c l i n i c a l practice and psychoeducat ion i n both the gifted and eating disorder fields. T h i s study benefits c l in ic ians , parents, researchers, and those who experience eating disorders by offer ing knowledge o f the experience o n l y gained through the perspective o f those who struggle w i t h it personal ly . T A B L E O F C O N T E N T S Abstract : i i Tab le o f Contents i i i L i s t o f Tables s v i i Acknowledgemen t s v i i i C H A P T E R I Introduction 1 Introduction to the Issue 1 Statement o f the P r o b l e m and Study Rat ionale 7 Purpose o f the Study 9 C H A P T E R JJ R e v i e w o f the Literature 13 Giftedness 13 Conceptual isat ions and Def in i t ions o f Giftedness 14 Deve lopment o f Gi f t ed G i r l s and Y o u n g W o m e n 18 E a t i n g Disorders A m o n g Adolescents 19 Spec i f ic Li tera ture-Eat ing Disorders A m o n g Gi f t ed Females and Adolescen ts . . . 22 Intellectual and Cogn i t i ve A b i l i t y Rela ted to Ea t ing Disorders 27 E m p i r i c a l Research R e v i e w o f Giftedness and P s y c h o l o g i c a l W e l l - B e i n g 30 S e l f Es teem, Se l f -Concept , E m o t i o n a l Res i l i ence and Gi f t ed 30 Perfec t ionism 34 Perfec t ionism and Ea t i ng Disorders 34 Perfec t ionism A m o n g Gi f ted 36 Qual i ta t ive Research in the Giftedness and Ea t i ng Disorder F ie lds 40 Qual i ta t ive Gi f t ed Research 40 Qual i ta t ive Research on Ea t ing Disorders 43 T h e Literature R e v i e w e d as it Relates to the Current Study 46 C H A P T E R m M e t h o d o l o g y 48 Research Questions 49 i v Def in i t ions 49 G i f t e d Adolescent . 49 Giftedness 50 Ea t i ng Disorder 50 Desc r ip t ive Phenomenology as a M e t h o d 50 Phenomeno log ica l Interviewing. . . . 52 Bracke t ing : Rat ionale and Procedure 53 B r a c k e t i n g o f Researcher 's Biases and Assumpt ions : Considerat ions o f the Researcher as a Subject ive Person 56 Recru i tment 58 Part icipant Select ion Procedures 59 Part icipant Characterist ics 60 Informed Consent 61 Interview Procedures and the Phenomenolog ica l Interview 62 Transcr ip t ion Procedures 64 Main tenance o f Conf ident ia l i ty 65 D a t a A n a l y s i s 66 Presentation o f F ind ings 7 2 E t h i c a l Considerat ions 73 Del imi ta t ions 74 D i v e r s i t y Issues 75 V a l i d i t y and R e l i a b i l i t y 76 C H A P T E R TV Resul ts 79 Situated Structures 80 Espr i t 8 0 A n d r e a 83 Phoen ix '. 88 E m i l y 91 Grace 96 M a r y 99 V Feedback F r o m Participants 103 Genera l Structure: F i n a l Themes and Sub-Themes 103 Theme 1: Negat ive Affec t and Self-Perceptions, E m o t i o n a l Pa in and Deter iorat ion 105 Theme 2: O v e r w h e l m e d and Conf l i c t ed 110 Theme 3: N o t F i t t ing : Incongruence and Awareness o f Differences 112 Theme 4: C o p i n g Through Engag ing i n the Ea t i ng Disorder 114 Theme 5: Exper ience o f Giftedness and Ea t ing Diso rde r and/or Struggle E x p l i c i t l y Connected 115 Theme 6: Per fec t ionism-St r iv ing to A t t a in "Perfect" 117 Theme 7: C o n t r o l and Res t r ic t ion 121 Theme 8: Awareness o f Mul t i f ace ted U n d e r l y i n g Factors 124 Theme 9: Sacr i f ice , Def iance and Separation: O f Self, o f B o d y , o f Needs 125 Theme 10: Apprec ia ted , Purposeful and M e a n i n g f u l Exper i ence 129 C H A P T E R V Di scus s ion 134 Signi f icance o f F ind ings i n L i g h t o f Previous Research 134 Conceptual isat ions o f Giftedness 135 Spec i f ic Literature Rela ted to Ea t ing Disorders A m o n g Gi f t ed Adolescents 137 Socie ta l Pressures, Sel f -Esteem, Perfec t ionism and Personal i ty Factors 141 Interesting and Unexpec ted Characterist ics o f the Da ta and Participants 144 Impl ica t ion o f the Study and F ind ings :'. 145 Exp lo ra t i on o f Or ig ina l Research Contr ibut ions 145 Impl icat ions F o r Psychotherapy, Psychoeducat ion, and Ea t ing Disorder Treatment 150 Impl ica t ions for Future Research 153 Strengths and L imi ta t ions o f the M e t h o d o l o g y and Study 155 Researcher 's Subject ive Exper ience 157 v i References 159 A p p e n d i x A : D S M I V - R Diagnos t ic Cr i t e r i a for Ea t i ng Disorders 169 A p p e n d i x B : Interview Pro toco l and E x a m p l e Interview Questions 171 A p p e n d i x C : Recrui tment Letter to Professional 173 A p p e n d i x D : Recrui tment Letter to Potential Participants : 174 A p p e n d i x E : Recrui tment A d v e r t i s i n g Poster 175 A p p e n d i x F : Adolescen t Subject Consent /Assent F o r m 176 A p p e n d i x G : Subject Consent F o r m 178 A p p e n d i x H : Parental Consent F o r m 180 LIST OF TABLES Table 1: T h e Exper ience o f an Ea t ing Disorder A m o n g Gi f t ed Female Adolescents : M a i n Themes and Sub-Themes : 104 A C K N O W L E D G M E N T S T h i s study c o u l d not have taken place without the wi l l ingness and trust o f the y o u n g w o m e n w h o volunteered to share their story and parts o f w h o they are. W i t h o u t them, this project w o u l d have remained but a twink le i n m y eye, a venture I felt was important but not actual ized. I thank each o f them for the pr iv i lege o f hearing the experience they so cand id ly and courageously shared, and I hope to create something f rom it that w i l l be wor thy o f the trust they gave to me i n do ing so. The strength o f the human spirit as it endures struggle is echoed i n their experiences. I w i s h them a l l much j o y and health i n their l ives . I thank D r . R i c h a r d Y o u n g , m y thesis supervisor, for his support, encouragement and dedicat ion to assisting me throughout this project. F r o m the in i t i a l m u s i n g about this topic , to the intensity o f the last several months, he has been wi th me each step o f the way , offer ing challenges, support, and record breaking proofreading. H e has mentored a commi tmen t to his students, a be l ie f i n understanding how to be wi th people, as w e l l as a strong research commitment . H e is an insightful and car ing man, as w e l l as a true academic, each o f these aspects o f his character has benefited me greatly. I thank both D r . M a r i o n Porath and D r . M a r i a A r v a y for be ing part o f this project as commit tee members . I real ize part icipating as commit tee members on this project was not a smal l task and they have both p rov ided an enthusiasm for this topic f rom the beginning . D r . Porath has p rov ided a sparkle w i th her posi t ive feedback and keen awareness and understanding o f giftedness. H e r expertise i n giftedness was a tremendous help when I questioned i f perhaps I was the on ly one who thought this project was wor thwhi le . D r . Ian D a v i s o n must be acknowledged for his feedback and edi t ing o f this thesis. N e u r o b i o l o g y has not qual i f ied h i m for this task, an extensive thesis experience o f his o w n , i x and more impor tant ly a sensitive and thoughtful nature has. I also thank m y f a m i l y and friends for their support and be l ie f i n me. The ones w h o put up w i t h m y computer v i g i l s , and m y need to chat about this, and to also chat about real l i fe , get extra thanks. E s p e c i a l l y D r . R u s s e l l D a y w h o happi ly put up wi th m y constant presence i n his lab w h i l e p r o v i d i n g a steadfast be l ie f i n me as person and as an academic. M a n y c l in ic ians and colleagues also supported me w i t h their enthusiasm for this topic, w i th insightful , and though-provoking emai ls and discussions, and also a wi l l ingness to consider assistance in recruitment o f the participants. F i n a l l y , I dedicate this w o r k to E v a n , m y favourite person i n the w o r l d , a l i t t le be ing that makes everything wor thwhi le . H e provided m u c h o f the energy to complete this project, as he reminded me da i ly that who I am as a person is more important than what I do. B y remind ing me o f that, I was able to b r ing who I am to this project and not lose m y s e l f i n it. I thank h i m for his love , for his spirit , for keeping me grounded i n the real w o r l d , and not car ing i f I ever graduated. 1 C H A P T E R I I n t r o d u c t i o n E a t i n g Disorders pose a significant threat to the phys ica l , emot ional and psycho log ica l we l l -be ing o f many female adolescents. The Na t iona l Ea t i ng Disorders Information Centre o f Canada ( N E D I C ) reports that A n o r e x i a N e r v o s a and B u l i m i a N e r v o s a affect at least 5% o f Canad ian women , typ ica l ly between the ages o f 14 and 30 ( N E D I C , 1995). D a n c y g e r and Gar f i nke l (1995) suggest that disordered eating, w h i c h m a y not meet the fo rmal diagnostic requirements o f c l i n i c a l eating disorders, are 2 to 5 t imes more l i k e l y to be diagnosed i n adolescent gir ls than any other group. Jones, Bennett , O lms ted , L a s o n and R o d i n (2001) found that i n a communi ty based sample o f Canad ian adolescents, 2 7 % o f adolescent gir ls between the ages o f 12 and 18 were found to be engaged i n disordered eating attitudes and behaviours . O f this sample, 2 3 % of the adolescents reported to be die t ing, 15% reported binge eating, 8.2% reported self- induced v o m i t i n g and 2 .4% were us ing diet p i l l s . O n l y 1.6% o f this sample had received an assessment or treatment related to disordered eating attitudes and/or behaviour. These f indings suggest that i n addi t ion to the vast number o f young Canad ian w o m e n w h o are c l i n i c a l l y diagnosed wi th an eating disorder, many other young w o m e n are engaged i n and may be phys i ca l ly and psycho log ica l l y c o m p r o m i s e d by disordered eating attitudes and behaviours. Introduction to the Issue Despi te the vast knowledge and ongoing research contributions i n the eating disorder f ie ld , empi r i ca l research specific to adolescent populat ions is underrepresented (Pratt, P h i l l i p s , Greydanus & Patel , 2003). A l t h o u g h some empi r i ca l literature addresses eat ing 2 disorders among adolescent populations, a review o f current publ i shed literature offers no quali tat ive contributions specific to the experience o f eating disorders among adolescents. T h e scarcity o f quali tat ive eating disorder literature represents a serious gap i n our knowledge base, especia l ly g iven the prevalence o f these disorders. T h e gap i n the knowledge base specific to gifted ind iv idua ls w h o experience eat ing disorders is also substantial. Qual i ta t ive and quantitative literature related to gifted adolescents w h o experience eating disorders is v i r tua l ly non-existent. T h i s study aims to f i l l the gap i n current literature by contr ibut ing qualitative f indings amongst a sample o f gifted female adolescents. A c a d e m i c contributions f rom the f i e ld o f both gifted educat ion and research and eating disorders provide the basis o f research rev iewed for this study, as l i t t le specif ic literature pertaining to this topic is currently available. M a n y personali ty and psycho log ica l characteristics o f adolescents have been found to relate to e t io logy and r isk factors inf luencing the development o f disordered eating. In a rev iew o f the current literature, M u s s e l l , B i n f o r d , and Fu lke r son (2000) cite l o w self-esteem, perce ived ineffectiveness, negative self-evaluation and perfect ionism as personali ty factors w h i c h m a y predispose an ind iv idua l to disordered eating. Other reviews o f the literature cite l o w self-esteem, body dissatisfaction, perfect ionism, h igh ratings o f importance o f peer acceptance and l o w competence o f phys ica l appearance as predisposing personali ty characteristics and r isk factors for disordered eating ( G u a l , et a l . 2002; L e o n , Fu lke r son , Perry, & Cudeck , 1993; M c V e y , Pepler , D a v i s , Flett & A b d o l e l l , 2002). H i g h personal standards and perfect ionism are w e l l documented i n the literature pertaining to eating disorders ( A s h b y & Ko t tman , 1998; Bas t ian i , R a o , W e l t z i n , & K a y e , 1995; Shafran & M a n s e l l , 2001). Literature also supports the h igh incidence o f 3 perfectionist ic tendencies among gifted adolescents (Baker , 1996; Greenspan, 2000; Nugent , 2000; Parker & M i l l s , 1996; Schuler , 2000; S i lve rman , 1999). S i l ve rman (1999) suggests that perfect ionism is the "least appreciated facet o f giftedness", and cites how perfect ionism is an " inev i tab le" aspect o f giftedness and "needs to be appreciated as a two-edged sword that has potential for p rope l l ing an ind iv idua l toward unparal le led greatness or p lummet ing one into despair" (p. 216) . It can be induced that psychosoc ia l and personality factors o f gifted female adolescents overlap w i t h r isk factors for disordered eating. Adolescen t females w h o are gifted have been found to have lower social and total self-esteem, more s ignif icant decreases i n self-esteem, decreased levels o f self-confidence and self-regard and increased levels o f perfect ionism, hopelessness and discouragement when compared to "non-gif ted" female adolescents ( K l e i n & Zehms , 1996; K l i n e & Short, 1991; L e a - W o o d & C l u n i e - R o s s , 1995). Offer ing another perspective, H o g e and R e n z u l l i (1993) found li t t le difference between the general self-concept o f gifted and non-gifted chi ldren. O v e r the last several decades, studies invest igat ing the intel lectual funct ioning o f adolescents exper iencing c l i n i c a l l y diagnosed eating disorders have y i e lded contradictory results. O v e r a l l , intel lectual performance among those diagnosed wi th eating disorders has been found to be representative o f a normal distr ibution (Dura & Borns te in , 1989; G U l b e r g , G i l l b e r g , Ras tam & Johansson, 1996; Ranseen & Humphr ies , 1992). In a rev iew o f this literature, B l a n z , Detzner , L a y , Rose and Schmid t (1997), address the dispari ty between results o f these studies and the c o m m o n c l i n i c a l observation o f h igh intel lectual funct ioning among adolescents diagnosed w i t h eating disorders. Shor tcomings o f previous studies are noted, and subsequent f indings suggest that, when compared to a matched control group, the 4 IQs o f the "patients" diagnosed wi th eating disorders were s ignif icant ly higher than those o f the patients i n the control group. A posi t ive correlat ion, w h i c h was weak yet s ignif icant , was found between weight loss before hospi ta l izat ion and intel l igence. T h e authors suggest that there m a y be a relat ionship and influence between h igh intel l igence, achievement mot iva t ion , and abi l i ty to successfully lose weight . It is suggested that further studies are necessary to investigate this relat ionship (B lanz et a l . , 1997). T h e studies relat ing to the intel lectual funct ioning o f ind iv idua l s exper ienc ing eating disorders p rov ide an important l i n k to the experience o f disordered eating among gifted adolescents and to the conceptualisat ion o f "giftedness" itself. T rad i t iona l ly giftedness has been conceptual ised and defined by h igh I Q (IQ above 130 or 2 standard deviat ions above the n o r m on standardized intel l igence tests) ( R e n z u l l i , 2002). O v e r recent years, theorists have contr ibuted var ious conceptualisations o f intel l igence related to giftedness (e.g., R a m o s -F o r d & Garner , 1997; Sternberg, 1997; Sternberg, 2003; H o g e & R e n z u l l i , 1993; R e n z u l l i , 2002) . Thus the def ini t ion o f "gif ted" continues to evolve and to remain controvers ia l . Jackson (1995) refers to many o f the c o m m o n characteristics, w h i c h m a y differentiate gifted ind iv idua ls : A d v a n c e d comprehension, unusual retentiveness, accelerated thought processes, unusual sensi t ivi ty to the expectations and feelings o f others, a sense o f be ing different, a need for just ice, perfectionistic tendencies and uneven development o f intel lectual , emot ional and phys ica l domains, (p. 33) S i l v e r m a n (1998) also refers to the "uneven" or "asynchronous development" o f gifted ind iv idua l s and suggests: Asynch ronous development is an attempt to understand the phenomenon 5 [giftedness] through the lens o f the gifted self, rather than the perspective o f society [and] highlights the complex i ty o f the i nd iv idua l ' s thought processes, the intensity o f sensation, emot ion, and imaginat ion, and the extraordinary awareness that results f rom this fusion. (Defini t ions o f Giftedness Sec t ion , H 4) T o reflect and respect the not ion o f asynchronous development among gifted adolescents, one def in i t ion o f giftedness used w i l l be that o f the C o l u m b u s G r o u p : "Gif tedness" is asynchronous development i n w h i c h advanced cogni t ive abil i t ies and heightened intensity combine to create inner experiences and awareness that are qual i ta t ively different f rom the norm. T h i s asynchrony increases w i t h higher intellectual capacity. The uniqueness o f the gifted renders them part icular ly vulnerable and requires modif icat ions i n parenting, teaching and counse l ing i n order for them to develop op t imal ly . (Co lumbus Group , 1991 as c i ted in Jackson, 1995; S i l v e r m a n , 1998, Def in i t ions o f Giftedness Sect ion, % 4) T h i s def ini t ion o f giftedness and its reference to asynchronous development reflect w e l l the not ion o f gifted adolescents be ing out o f step wi th in themselves, and also w i t h their peers. Deve lopmenta l potential and psychic overexci tabi l i t ies are also salient to the experience and ident i f icat ion o f giftedness. Deve lopmenta l potential is defined as "the i n d i v i d u a l ' s constel lat ion o f talents, special abil i t ies, and intel l igence, plus the f ive ways o f processing the data o f experience" (Introduction Sect ion, f 2). The f ive ways o f process ing refer to what are defined as psychomotor , sensual, intel lectual , imagina t ional and emot ional overexci tabi l i t ies (P i echowsk i , 1997; P i e c h o w s k i & M i l l e r , 1995). Overexc i tab i l i t i es and the 6 associated intensity or heightened experience are also v i ewed as important i n the development and ident if icat ion o f giftedness, and this is also reflected w e l l i n the chosen operational def ini t ion o f this study ( A c k e r m a n & Paulus , 1997; Jackson, 1995; P i e c h o w s k i & M i l l e r , 1995; P i e c h o w s k i & Co lange lo 1984; P i e c h o w s k i , 1997). T h e B . C M i n i s t r y o f Educa t ion guidelines (2002) consider a student gifted when: she/he possesses demonstrated or potential abil i t ies that g ive evidence o f except ional ly h igh capabi l i ty w i th respect to intellect, creat ivi ty or the sk i l l s associated w i t h specific discipl ines . Students w h o are gifted often demonstrate outstanding abil i t ies i n more than one area. T h e y may demonstrate extraordinary intensity o f focus i n their particular areas o f talent or interest. (Identification and Assessment Sec t ion , f 2) It is suggested that no single cr i ter ion should be used i n the ident if icat ion o f gifted students and that mul t ip le cr i ter ia and sources o f identif icat ion should be u t i l i zed . It is suggested that cr i ter ia shou ld inc lude several o f the f o l l o w i n g : Teacher observations inc lud ing anecdotal records, checklis ts and inventories; records o f student achievement inc lud ing assignments, portfol ios , grades and outstanding talents, interests and accomplishments ; nominat ion by educators, parents, peers and/or self; interviews o f parents and students; and formal assessments to l eve l C o f cogni t ive abi l i ty , achievement, aptitude and creativity. ( B . C . M i n i s t r y o f Educa t ion , 2002; Identification and Assessment Sec t ion , f 2) 7 Statement of the Problem and Study Rationale F e w studies refer speci f ica l ly to disordered eating among gifted females al though the existence o f the phenomenon is a l luded to i n various publ icat ions (e.g., Jackson & Peterson, 2003; Johnston, 1996; Ker r , 2000; K e r r & N i c p o n , 2003; Nugent , 2000, Peterson, 1998; S i l ve rman , 1994). Different ia t ing characteristics o f gifted ind iv idua l s suggested by Jackson (1995) also reflect many o f the r isk factors associated wi th disordered eating. Jackson and Peterson (2003) suggest that without appropriate support gifted adolescents m a y be prone to "anxiety states, depressive disorder, eating disorders, and obsess ive-compuls ive behaviors" (p. 177). Ga t to -Walden (1999) reflects on her c l i n i c a l experience counse l l ing gifted w o m e n and female adolescents exper iencing disordered eating. She suggests that among gifted clients s t ruggling w i t h disordered eating, several characteristics are c o m m o n . These characteristics inc lude: "personal identity that has d i sowned be ing gifted, debi l i ta t ing . perfect ionism, excessive need to please others, experience o f i so la t ion and lonel iness, stressful transit ion dur ing the onset o f the disorder and f ami ly dynamics w h i c h m a y inc lude : overprotect ion, enmeshment, perfectionistic f ami ly standards and abuse or addict ive behaviour" (p. 119). Garner (1991), an inf luent ial researcher i n the f ie ld o f disordered eating, addresses the "nature and scope o f the p rob l em" o f disordered eating among gifted adolescents. Garner suggests that "potential predisposing factors...seem part icular ly relevant to those w h o m a y be ident i f ied as g i f t ed . . . " (p. 52). Garner (1991) asserts that gifted adolescents "may be more vulnerable to the development o f both anorexia nervosa and b u l i m i a nervosa because [they] possess many traits that have been identif ied as r i sk factors for eating disorders" (p. 61) . Garner describes a number o f possible factors inf luencing the development o f eat ing 8 disorders among gifted adolescents, w h i c h include: compet i t ive settings, weight loss as "another area for d i sp lay ing personal competence", l o w self esteem, perfect ionism, interactional and f a m i l y patterns and educational programs w h i c h focus on performance, personal mastery, and vocat ion , poss ib ly neglect ing other important areas o f female p sycho log ica l development (p. 53). B a s e d on a review of empi r i ca l literature, Niehar t (1999) asserts, "It is clear that giftedness influences the psycho log ica l we l l -be ing o f ind iv idua l s " (Introduction section, 11). Whether giftedness contributes to psycholog ica l funct ioning i n a posi t ive or negative w a y continues to be a matter o f debate. H o w giftedness affects psycho log ica l funct ioning m a y be largely dependent on various factors, i nc lud ing the unique characteristics o f gifted ind iv idua l s and their environment. It is not m y intention to argue that gifted adolescents are more vulnerable to psycho log ica l dysfunct ion, although giftedness inevi tably affects ind iv idua l s i n a variety o f ways and i n many aspects o f their l i v e d experience. It is not m y intention to argue that a l l adolescents w h o experience disordered eating are gifted. Such an assumption w o u l d most certainly be a gross overgeneral izat ion. It is also not m y intention to relate a l l o f the characteristics o f gifted adolescents to the development o f disordered eating, al though some of the features o f giftedness may be conceptual ised as predisposing or as pos ing r i sk factors related to the development o f disordered eating for adolescent females (i.e. perfect ionist ic tendencies, l o w self esteem, unusual sensi t ivi ty to the expectations and feelings o f others, decreased levels o f self-confidence and self-regard, competi t iveness, etc.). It is m y intention to investigate and describe the l i v e d experience, meaning and core and c o m m o n themes o f disordered eating among a sample o f gifted female adolescents. 9 Adolescents w h o are gifted may articulate the experience o f disordered eating i n a unique way , and their "developmental potent ia l" and "overexci tabi l i t ies" may be art iculated through the construct ion o f meaning i n their l i v e d experiences. T h i s bias was careful ly bracketed pr ior to in te rv iewing and data analysis, as were a l l other personal reflections and beliefs regarding disordered eating, par t icular ly among this popula t ion. T h e p rob lem addressed was: W h a t is the l i v e d experience and meaning o f disordered eating among gifted female adolescents? I sought to explore this phenomenon i n an in-depth manner and to describe the core and c o m m o n themes o f the l i v e d experience o f disordered eating for gifted adolescent females. T h e phenomenon w i l l be presented through the vantage point o f the part icipants ' personal experience and every attempt was made to describe their experience w h i l e remain ing faithful to communica t ion o f their stories as subject ively exper ienced b y them. It is important to note that the study and findings are situated i n a part icular soc ia l context and western culture. Purpose of the Study " A s k anyone w h o manages a secondary level gifted program about eating disorders and they w i l l undoubtedly say that it is a serious concern ." (Peterson, 1998, p. 197) T h e purpose o f this study was to explore the experience o f eating disorders among a sample o f gifted female adolescents. The meaning that the participants ascribed to the experience o f hav ing an eating disorder, and the core and c o m m o n themes in their experience was exp lored and described. 10 M y c l i n i c a l experience w o r k i n g wi th young w o m e n struggling w i t h disordered eating i n an outpatient mental health setting has conf i rmed m y be l ie f that eating disorders pose a l i fe-al ter ing struggle, f i l l ed w i th emot ional pain , and self-examination. I a m cont inua l ly i n awe o f the maturity, insight, determination and resi l ience o f some o f m y clients despite their da i ly struggle w i t h their eating disorder and attempts to chal lenged the under ly ing contr ibut ing factors. Disordered eating for any adolescent is a complex and inherently enigmatic experience that may not be captured fu l ly w i th in a quantitative paradigm. T h i s study sought to contribute knowledge to the f i e ld o f eating disorders w i t h research that is c lose to the human experience o f the participants. The C o l u m b u s group def ini t ion o f giftedness emphasizes many o f the unique characteristics o f gifted ind iv idua ls : " A d v a n c e d cogni t ive abil i t ies and heightened intensity combine to create inner experiences and awareness that are qual i ta t ively different f r o m the n o r m . . . " ( C o l u m b u s G r o u p , 1991 as c i ted i n S i lve rman , 1998, Def in i t ions o f Giftedness Sec t ion , 14). I f the experiences and awareness o f gifted adolescents are qual i ta t ively different f rom the no rm, a descript ion and explorat ion o f this subjective experience and the associated meaning is valuable. Unfortunately this study w i l l not provide compar i son to a "non-gif ted" popula t ion. The prevalence and presentation o f eating disorders among gifted adolescent females are u n k n o w n , despite be ing discussed or suggested i n several publ icat ions (Garner, 1991; Ga t to -Walden , 1999; Niehar t , 1999; Nugent , 2000; Peterson, 1998; S i l ve rman , 1994). The lack o f research i n this area, despite its reference i n the literature, represents a gap i n academic and c l i n i c a l knowledge . In f i l l i n g this gap wi th a phenomenolog ica l inqu i ry , a descr ipt ion o f the l i v e d experience may be gained f rom the participants. Adolescents 11 whose emot ional and cogni t ive development may be considered "advanced" m a y articulate their experience i n a manner that is also advanced, and that poss ib i l i ty a l lows for considerat ion o f its relevance to non-gifted adolescents. T h i s study can be considered one o f d iscovery and descript ion. Literature relat ing to eating disorders and also gifted identif icat ion and development, addresses the need for quali tat ive data to p rov ide the leve l o f depth and meaning associated w i t h understanding l i v e d experience ( C o l e m a n & Cross , 2000; Garrett, 1997; H o s k i n s , 2002; K u n k e l & C h a p a 1992; M a t o f f & Matof f , 2001). K u n k e l and C h a p a (1992) refer to the essential nature o f research that focuses on gifted experience. M a t o f f and M a t o f f (2001) assert that the process and experience o f disordered eating and recovery f rom a c l ient ' s account "has potential to be a r i ch source o f untapped in fo rma t ion . . . " (p. 44). H o s k i n s (2002) notes that despite substantial research attention i n v o l v i n g eating disorders, "an in-depth understanding o f the complex i ty o f this disorder has fal len short i n many w a y s " based on tradit ional methods o f inqu i ry (p. 231). H o s k i n s (2002) also suggests this shor tcoming and a focus on i n d i v i d u a l pathology have "neglected to truly understand the l i fewor lds o f gir ls i n contemporary society" (p. 232) . Garrett (1997) refers to the many aspects o f the experience o f eating disorders that cannot or are not thoroughly examined through quantitative means and argues that there exists a lack o f indicators o f posi t ive outcomes and recovery i n current research. These indicators o f recovery may on ly be e l ic i ted by the stories o f those exper ienc ing and recover ing f rom eating disorders (Garrett, 1997). C o l e m a n and Cross (2000) c a l l for research that addresses the personal , l i v e d experiences o f gifted ind iv idua ls and describe the undertaking o f such research as a "potent ial ly fruitful area" (p. 208). C o l e m a n and Cross speci f ica l ly identify research such as 1 2 phenomenology, which may explore social and emotional factors, meaning and understanding of experience among gifted individuals, as valuable and underrepresented in gifted literature. A re-emphasis of the Columbus group definition of gifted accentuates the importance of appreciating the unique qualities of gifted individuals and consideration of those qualities in counselling and educational settings. M y own understanding of this phenomenon w i l l be deepened and my clinical knowledge broadened. Through presentation of these research findings, this may also be the case for other professionals working within the academic or clinical realms of gifted or eating disorder counselling, treatment, prevention and education. Individuals who struggle with disordered eating, perhaps gifted and non-gifted, and others whose lives are touched by the experience may find the results offer new insight, or that parts of the participants' experience resonate with them. The participants of this study have given of themselves by sharing their story, many with the hopes of helping someone else or contributing knowledge that they also seem to feel is lacking. The potential for this research to impact some or many, fueled its inception and allowed it to come forth. 13 C H A P T E R II Review of the Literature A s mentioned, the current literature pertaining to eating disorders among gifted adolescents is not w e l l developed. T o provide a so l id foundation for the ideas exp lored i n this thesis, the literature that does exist is addressed and is also supplemented by other areas o f research i n the eating disorder and giftedness fields. T h i s review explores the topics o f giftedness, its conceptualisations and definit ions i n current literature, development o f gifted adolescents and young w o m e n , and eating disorders among adolescents. It also highl ights sociocul tura l , e t io log ica l and r isk factors related to eating disorders c i ted i n literature reviews, and intel lectual and cogni t ive abi l i ty as it relates to eating disorder populat ions . Per fec t ion ism and psychosoc ia l variables, p r imar i l y self-esteem and self-concept, are elaborated on as they are seen as over lapping themes frequently c i ted i n literature relevant to both gifted and eating disorder populations. A sample o f qualitative research i n both f ields, w h i c h addresses the experience o f giftedness, giftedness as it relates to the experience o f depression among gifted adolescents, and the experience o f eating disorders are out l ined. Giftedness T h e f i e ld o f gifted education and research is vast and the amount o f literature addressing the definit ions and conceptualisations o f various forms o f giftedness and its appl ica t ion to research is ove rwhe lming . In an attempt to lay sufficient g roundwork for the purposes o f this research study, I have incorporated a sample o f current and relevant literature that addresses the f i e ld o f giftedness. I g ive part icular emphasis to the d i f f icu l ty i n 14 concretely def in ing gifted, examples o f multifaceted approaches to def ining giftedness, and gender and female development among gifted populat ions. Conceptualisations and Definitions of Giftedness H o g e and R e n z u l l i (1993) address the "controversies" and "ambigui t ies" i n def in ing the construct o f giftedness, its measurement, and the various ways that it m a y be conceptual ised (p. 450) . M o r e l o c k (1996) also refers to the controversies i n def in ing giftedness and the ways i n w h i c h research is affected amidst the "morass o f confus ion" (Introduction section, 11). The di f f icul ty i n ana lyz ing and conduct ing research i n the f i e ld o f giftedness poses many d i lemmas as suggested by H o g e and R e n z u l l i , due to the disagreement and var ious ways i n w h i c h the construct may be appl ied in research studies. T h e y emphasize the var iab i l i ty i n h o w the construct o f giftedness is defined and operat ional ised not ing that i n some instances it is narrow, for example on ly consider ing "h igh ly except ional intel lectual capacit ies", and i n others more broad, consider ing "intel lectual , mot iva t iona l and artistic d imens ions" (p. 450) . T h e variety o f objective and subjective ways i n w h i c h narrow and broad defini t ions are measured is also noted as contr ibut ing to the diff icul t ies i n s tudying giftedness. R e n z u l l i (2002) describes "past and present definit ions o f giftedness" w i t h a survey o f "conservat ive" to " l i b e r a l " definit ions o f giftedness (p. 67). R e n z u l l i considers l ibera l defini t ions o f giftedness, such as those that on ly consider h igh I Q , to be restrictive and less consistent w i th current approaches to conceptual is ing intel l igence and giftedness, such as those proposed by Sternberg (1997, as c i ted i n R e n z u l l i , 2002), Gardner (1983 as c i ted i n R e n z u l l i , 2002) , or R e n z u l l i (1978 as c i ted i n R e n z u l l i , 2002). Def in i t ions and 15 conceptualisat ions o f giftedness such as these are seen as mult ifaceted and to take into account var ious forms o f intel l igence. R e n z u l l i (2002) suggests that no s ingle cr i ter ion should be used to classify giftedness, although he notes that i n general, groups o f traits such as above average abi l i ty (both general and specif ic) , task commitment , and creat ivi ty are possessed by gifted ind iv idua l s . R e n z u l l i refers to this not ion o f giftedness as the 3-r ing concept ion o f giftedness. A br ie f g l impse o f other multifaceted, and less restrictive conceptualisat ions o f giftedness such as those proposed by Sternberg (1997, 2003), R a m o s - F o r d and Gardner (1997), and V o n K a r o l y i , R a m o s - F o r d and Gardner (2003), provide further, less conservat ive defini t ions, and propose considerat ion o f various forms o f intel l igence. Sternberg (1997, 2003) also suggest that identif icat ion o f giftedness must take into account var ious forms o f intel l igence, otherwise various forms o f giftedness or gifted ind iv idua ls m a y be ove r looked by this c lass i f ica t ion. Sternberg's (1997, 2003) tr iarchic v i e w o f giftedness considers analyt ica l , synthetic and practical giftedness. A n a l y t i c a l giftedness relates to p r o b l e m so lv ing and reasoning and is the aspect o f giftedness most readi ly measured by standardized intel l igence tests. .Synthetic or creative giftedness is seen as prominent i n ind iv idua l s w h o are " ins ight ful , in tui t ive, creative, or just p la in adept at cop ing w i t h re la t ively n o v e l si tuations" and is less eas i ly measured through standardized tests (Sternberg, 1997, p. 44) . Prac t ica l giftedness invo lves the way i n w h i c h an ind iv idua l pragmat ica l ly applies analyt ic and synthetic abil i t ies . V o n K a r o l y i , R a m o s - F o r d and Gardner (2003) refer to intel l igence and giftedness as mul t ip le i n nature. T h e complex i ty and variety i n mul t ip le intel l igences continue to evo lve and chal lenge notions o f intel l igence measured by intel lectual ly focused measures. V o n 16 K a r o l y i , R a m o s - F o r d and Gardner (2003) identify eight mul t ip le intel l igences w h i c h inc lude: 1) l inguis t ic , 2) logical -mathemat ical , 3) mus ica l , 4) spatial, 5) bodi ly-kines thet ic , 6) interpersonal, 7) intrapersonal, and 8) naturalistic. A ninth intel l igence, w h i c h is be ing val idated and explored, is existential intel l igence and is defined as "an interest and concern w i t h 'ul t imate i ssues ' " and "ponder ing the fundamental questions o f existence" (p. 102). T h e existent ial intel l igence out l ined here seems to fit w e l l w i th conceptualisat ions o f giftedness that inc lude overexci tabi l i t ies and the propensity o f gifted ind iv idua l s to experience existential depression (e.g. Jackson, 1995; Jackson & Peterson, 2003) or spir i tual giftedness as described by P i e c h o w s k i (2003). V o n K a r o l y i , R a m o s - F o r d and Gardner (2003) note the importance o f seeing mul t ip le intell igences as often separate f rom each other, and to remain aware o f the possible "asynchrony" o f such intell igences among gifted ind iv idua l s . S i l v e r m a n (1998) suggests that definit ions o f giftedness such as those proposed by the C o l u m b u s G r o u p (1991), attempt to define giftedness "through the lens o f the gifted s e l f . Def in i t ions and conceptualisations o f giftedness such as these h ighl ight the " c o m p l e x i t y o f the i n d i v i d u a l ' s thought processes, the intensity o f sensation, emot ion , and imagina t ion , and the extraordinary awareness that results f rom this fus ion" (Co lumbus G r o u p , 1991 as c i ted i n S i lve rman , 1998, Def in i t ions o f Giftedness Sect ion, f 4). Schu l t z and D e l i s l e (2003) suggest that what identifies gifted adolescents is as unique as the adolescents themselves. It is suggested that intellectual , psychomotor , emot iona l , sensual, and imaginat ional overexci tabi l i t ies as referred to by P i e c h o w s k i (1991, as c i ted i n Schul tz & D e l i s l e 2003) based on the w o r k o f D a b r o w s k i (1964, as c i ted i n Schu l t z & D e l i s l e 2003) m a y affect every rea lm of gifted adolescents' experience. Strategies to support and 17 nurture gifted adolescents dur ing a cr i t ica l developmental phase are suggested w h i l e keep ing i n m i n d unique developmental needs. Several theorists and researchers i n the f ie ld o f giftedness refer to heightened sensit ivit ies, awareness, and "overexci tabi l i t ies" among gifted ind iv idua l s (e.g. A c k e r m a n & & Paulus , 1997; Bouche t & F a l k , 2001 ; Jackson, 1995; Jackson & Peterson, 2003; Schu l t z & D e l i s l e , 2003; S i lve rman , 1994, 1998; P i e c h o w s k i , 1997, 2003). Such theorists refer to the importance o f cons ider ing such overexci tabi l i t ies i n the conceptualisat ion and understanding o f giftedness. A c k e r m a n and Paulus (1997) refer also to diff icult ies i n the measurement and def in i t ion o f giftedness, and propose measurement o f psych ic overexci tabi l i t ies ident i f ied by D a b r o w s k i (1964, as c i ted i n A c k e r m a n & Paulus 1997) i n the ident i f icat ion o f gifted adolescents. F i v e overexci tabi l i t ies , psychomotor , sensual, imagina t ional , intel lectual and emot ional , are considered and defined as developmental potentials. Grant and P i e c h o w s k i (1999) suggest that many conceptualisations o f giftedness focus less on the inner experience o f gifted ind iv idua l s than those that consider overexci tabi l i t ies . P i e c h o w s k i (1997) describes and elaborates on the f ive "forms and expressions o f overexci tabi l i t ies" . A br ie f out l ine o f these includes: 1) Psychomotor overexci tabi l i ty as i n v o l v i n g a "surplus o f energy " or "psychomotor expression o f emot ional tension", 2) Sensual overexci tabi l i ty as i n v o l v i n g " enhanced sensory and aesthetic pleasure" and "sensual expression o f emot ional tension", 3) Intellectual overexci tabi l i ty as i n v o l v i n g "intensif ied act ivi ty o f the m i n d " , "penchant for p rob ing questions and p rob lem s o l v i n g " and "reflective thought", 4) Imaginat ional overexc i tab i l i ty as i n v o l v i n g "free p lay o f imagina t ion" , "capacity for l i v i n g i n the w o r l d o f fantasy", "spontaneous imagery as an expression o f emot ional tension" and " l o w tolerance for boredom", 5) E m o t i o n a l overexci tabi l i ty as i n v o l v i n g "feelings and emotions 18 intensif ied", "strong somatic expressions", "strong affective expressions", "capaci ty for strong attachments, deep relationships, well-differentiated feelings toward the s e l f (pp. 368-367). These overexci tabi l i t ies are often characterized as heightened exper iencing, or ways i n be ing i n the w o r l d experienced by gifted adolescents. P i e c h o w s k i (2003) focuses attention on emot ional giftedness and overexci tabi l i t ies and also incorporates spir i tual giftedness i n recent conceptualisations o f giftedness. Jackson and Peterson (2003) emphasize the need for c l in ic ians and educators to be aware o f the relat ionship between these overexci tabi l i t ies and psycho log ica l distress or maladjustment among gifted adolescents, and outline c o m m o n traits possessed by h i g h l y gifted adolescents. Introversion characterized by a " r i ch inner l i f e " , heightened sensi t ivi ty , and overexci tabi l i t ies among gifted chi ldren are seen as p lac ing these ch i ld ren "at odds w i t h their various contexts" and they may experience being "out o f sync" or i n a "state o f inner d i s e q u i l i b r i u m " (p. 177). Development of Gifted Girls and Young Women Si lve rman (1994) describes adolescence as a "precarious per iod for gifted g i r l s " (p. 141). S i l v e r m a n notes that societal messages force a choice between giftedness and femin in i ty for gifted adolescent gir ls . Adolescence is seen as a vulnerable t ime for gifted adolescent gir ls , when societal pressures related to thinness and attractiveness m a y render these young w o m e n vulnerable to disordered eating. K e r r (2000), a noted researcher i n the area o f gifted female development, remarks on the changes in w o m e n and g i r l s ' roles and soc ia l iza t ion i n past several decades. A l t h o u g h they n o w engage i n more t radi t ional ly male roles, K e r r (2000) suggest that young w o m e n are "oppressed more than ever by societal images o f the 'perfect ' w o m a n " (p. 649). K e r r also comments on the d i l e m m a faced by adolescent females to actualize their gifted potential , yet to continue to meet the requirement o f t radit ional female roles, and the needs o f others, both at home and i n the larger communi ty . K e r r (2000) challenges the notions that gifted adolescent females are somehow protected f r o m socia l pressures or maladjustment due to their intel l igence or abi l i ty and cal ls for means o f ident i f icat ion and strategies to support these young w o m e n as they transit ion to adulthood. K e r r and N i c p o n (2003) suggest that gifted young w o m e n are adept at adjusting to "soc ie ty ' s expectat ion" o f them (p. 490). Sands and H o w a r d - H a m i l t o n (1995) address depression among gifted female adolescents, and speak to the inevitable pressures and m i x e d messages exper ienced throughout this developmental stage. It is suggested that l i fe for these adolescents can be "extremely complex and frustrating" w h i l e they identify and attempt to con fo rm to societal expectations related to gender role and the "diverse pul l s on their psyche" (% 2; f 4) . A s w i t h m u c h o f the literature related to gifted female adolescent development, it is v i e w e d as a t ime when these young w o m e n , who may have prev ious ly been encouraged to f u l f i l l their gifted potential are then concurrent ly pressured by the emerging demands to meet the requisite societal gender roles and ideal images o f w o m e n (Sands & H o w a r d - H a m i l t o n , 1995). Eating Disorders Among Adolescents Gif t ed adolescent females may have unique experiences o f societal pressures, yet those pressures exist and may affect a l l adolescent females. The experience o f disordered eating as it relates to societal and gender role expectations and pressures w i l l be br ie f ly 20 explored , as w i l l personali ty variables and r isk factors among adolescents that may be related to the development o f eating disorders. Slater, Guthr ies and B o y d (2001) rev iew literature pertaining to adolescent mental health issues such as depression, eating disorders, substance abuse, v io lence and abuse through a feminist perspective. It is suggested "notions and roles o f feminin i ty , that are both expected and devalued" are taught at a young age to girls (p. 443) . It is the pressure o f these roles that m a y lead to psycho log ica l health r isks and a disproportionate number o f adolescent • females deve lop ing eating disorders. In a rev iew o f current literature pertaining to eating disorders among adolescents, Pratt, P h i l l i p s , Greydanus and Patel (2003) refer to the scarcity o f empi r i ca l research i n the f i e ld o f eating disorders specific to adolescent populat ions, despite more attention to this topic i n recent years. The authors suggest that research i n the eating disorder f i e ld is fraught w i t h design f laws, and part icular ly neglects populat ions o f adolescents as the p r imary or exc lus ive focus o f research studies. A s the onset o f eating disorders is t yp i ca l ly dur ing adolescence, and as a significant proport ion o f the w o r l d ' s populat ion fa l l into this category, this leaves a gap in the current state o f knowledge (Pratt, P h i l l i p s , Greydanus & Pate l , 2003) . The r i s ing incidence o f eating disorders among adolescents in various cultures is noted. T h e study o f eating disorders specific to adolescents through a developmental perspective is warranted, both due to the fact that adolescents may have been engaging i n eating disordered behaviour for a shorter per iod o f t ime, and hence may respond more readi ly and pos i t ive ly to treatment, and also due to the fact that eating disorders may occur at c r i t i ca l stages o f maturation or development (Steiner & L a s k , 1998, as c i ted i n Pratt, P h i l l i p s , Greydanus & Patel , 2003). 21 Pratt, P h i l l i p s , Greydanus and Patel (2003) identify several predisposing or r i sk factors (b io log ica l and genetic, phys io log ica l , and health behaviour factors) that m a y relate to the development o f eating disorders among adolescents. T h e y conclude that no def in i t ive or clear evidence exists that sheds l ight on w h i c h adolescents may or m a y not u l t imate ly develop an eating disorder. R e v i e w o f the current literature suggests that c o m m o n c o m o r b i d disorders among adolescents w i th eating disorders are "depression, anxiety, substance abuse, obsess ive-compuls ive disorders, personality disorders, and post-traumatic stress disorders" (p. 302). Pratt, P h i l l i p s , Greydanus and Patel suggest that studies exp lo r ing c o m o r b i d disorders m a y be skewed due to participant samples being recruited f rom psychia t r ic or spec ia l ized eating disorders treatment centers, where psychopathology m a y be more serious or mul t ip le pathologies may exist. It is conc luded that regardless o f the true state o f c o m o r b i d condi t ions among adolescents w h o experience eating disorders, it is d i f f icul t to determine w h i c h disorder was pre-exist ing. Pratt, P h i l l i p s , Greydanus and Patel r ecommend many directions for future research specific to the prevalence, r isk, e t io logy and treatment o f eating disorders among adolescents. A significant amount o f literature addresses possible personali ty and r isk factors that may contribute to the development o f eating disorders among adolescents. M u s s e l l , B i n f o r d and Fu lke r son (2000) explore personali ty and r isk factors that may contribute to eating disorders f rom a prevent ion stance. Based on review of currently avai lable research, they suggest that personali ty r isk factors for eating disorders inc lude negative self-evaluation, l o w self-esteem, and perceived ineffectiveness, us ing eating disorders to cope w i t h feelings o f inadequacy, and negative emotional i ty , w h i c h poses a greater r isk when c o m b i n e d w i t h other r i sk factors. A th l e t i c , developmental , traumatic, f a m i l i a l , and b io log i ca l factors, as w e l l as 22 sociocul tura l factors such as societal preoccupation wi th weight , thinness and die t ing as they relate to culture and gender may also be predominant r isk factors. G u a l , et a l . (2002) explored self-esteem and personali ty variables as they relate to r isk factors for eating disorders among a large sample o f adolescent w o m e n (n= 2862 females f rom a national sample i n Spain) , as part o f a representative baseline sample to be exp lored through a later prospect ive study. L o w self-esteem and h igh levels o f neuro t ic i sm described as "related to perfect ionism, r ig id i ty , meticulousness, [and] concern over mis takes" were found (p. 270) . M c V e y , Peplar , D a v i s , Flett , and A b d o l e l l (2002) used a cross-sectional des ign to explore both r i sk and protective factors for disordered eating among adolescents, based on a rev iew o f pertinent research. F a m i l i a l support, perfect ionism (prescribed by se l f and b y others), negative self-perceptions o f appearance and socia l acceptance were their f oc i . F ind ings include: "h igh self-oriented perfect ionism, l o w competence ratings for phys i ca l appearance, h igh self ratings o f importance o f socia l acceptance by peers, and l o w paternal support" as related to disordered eating (p. 88). Specific Literature-Eating Disorders Among Gifted Females and Adolescents A thorough review o f current literature identif ied that disordered eating among gifted ind iv idua l s is rarely speci f ica l ly addressed. Ea t ing disorders are commented on and a l luded to i n several articles related to gifted adolescent development and perfect ionism among gifted ind iv idua l s (Nugent, 2000; Peterson, 1998; S i lve rman , 1994; 1999). The l ack o f research articles spec i f ica l ly pertaining to gifted females and disordered eating, either quali tat ive or quantitative, represents a gap i n the literature. F e w articles other than Garner (1991) and 23 Ga t to -Walden (1999) address this area specif ical ly , and both articles are based o n l y on anecdotal evidence, c l i n i c a l op in ion and reference to other related literature sources. A l t h o u g h the expertise and insight shared by these authors is valuable, to m y knowledge a research-based approach to this area has not been publ ished. S i l v e r m a n (1994) examines the preoccupation w i t h weight and appearance among gifted adolescents gir ls . The impact o f the societal value o f attractiveness rather than achievement or intel l igence among gifted adolescent gir ls is discussed. T h e development o f eating disorders, weight and appearance preoccupations among gifted gir ls and a need for soc ia l acceptance are emphasised. K e r r (2000) and K e r r and N i c p o n (2003) refer to eat ing disorders and preoccupat ion w i t h phys ica l appearance as "at r i sk" behaviours among gifted adolescents, as they are keenly aware and perceptive o f societal expectations and pressures on them. S i l v e r m a n (1999) addresses perfect ionism among gifted ind iv idua l s , and its relat ionship to eating disorders is a l luded to i n this article. S i l v e r m a n emphasizes that among gifted ind iv idua l s "perfect ionism needs to be appreciated as a two-edged sword that has potential for p rope l l ing an ind iv idua l toward unparal leled greatness or p l u m m e t i n g one into despair" (p. 216) . Peterson (1998) notes many o f the particular soc ia l and p sycho log i ca l vulnerabi l i t ies o f gifted adolescents. Based on professional experience and anecdotal evidence, it is suggested that among secondary-level gifted students eating disorders pose a "serious concern" (p. 197). K e r r and N i c p o n (2003) suggest that gifted young w o m e n are h igh ly sensitive to understanding "socie ty 's expectations" o f them and m a y be susceptible to the pressure o f and meaning o f thinness (p. 490) . Ea t i ng disorders among gifted adolescents 24 are seen as poss ib ly hav ing a distinct meaning among this populat ion that may differ f rom non-gifted peers, or relate to achievement needs. Niehar t (2000) addresses the topic o f eating disorders among gifted ind iv idua l s i n a rev iew o f the empi r i ca l literature o f the impact o f giftedness on psycho log ica l we l l -be ing . T h i s article examines several research studies that have investigated the intel lectual funct ioning o f ind iv idua l s exper iencing eating disorders. B y def in ing gifted on ly b y intel lectual funct ioning or I Q , Niehar t (1999) has not incorporated other elements o f diverse defini t ions o f giftedness. T h i s may be expected g iven that on ly empi r i ca l research is rev iewed, and I Q is the most typ ica l means through w h i c h giftedness has been operat ional ized i n empi r i ca l research. Despi te suggesting a rev iew o f empi r i ca l research, Niehar t (1999) refers i n detail to Garner ' s (1991) article addressing gifted adolescents and eating disorders, w h i c h is not based on specific research f indings. Niehar t (1999) presents results f rom a sma l l selection o f articles addressing the intel lectual funct ioning o f ind iv idua l s exper iencing eating disorders. The exis t ing controversy between whether eating disorder samples exhibi t h igh intel lectual funct ioning or intel lectual funct ioning that is w i t h i n a normal statistical dis t r ibut ion, is addressed. Ar t i c l e s such as D a l l y and G o m e z (1979) and R o w l a n d (1970) are presented to support the v i e w that intel lectual funct ioning among ind iv idua l s w h o experience eating disorders may be above average. D a l l y and G o m e z (1979) found that I Q scores o f 130 or greater were found i n over 9 0 % o f an adolescent eating disorder sample, and R o w l a n d (1970 as c i ted in Niehart , 1999) found I Q scores o f 120 or above among a sample o f eating disorder patients. In contrast to these f indings , an article by T o u y z , B e u m o n t and Johnstone (1986 as ci ted i n Niehart , 1999) is presented w h i c h found that the I Q scores o f eating disorder patients d i d not vary f rom the normal dis t r ibut ion o f I Q 25 scores w i t h i n the general populat ion. L i t t l e detail regarding the sample or methods used i n the selected studies presented is g iven and recently publ i shed articles w i th this specif ic focus are neglected. Ga t to -Walden (1999) reflects on her c l i n i c a l experience counse l l ing gifted w o m e n and female adolescents exper iencing disordered eating. She asserts that the percentage o f gifted female adolescents and adults exper iencing disordered eating i n her counse l l ing practice has increased dramat ical ly i n recent years. T h i s article is one o f the few that spec i f ica l ly addresses disordered eating issues and counse l l ing among gifted adolescents and w o m e n . L i t t l e research evidence is presented i n this article and m u c h o f the informat ion g iven i n based on ly on c l i n i c a l observations. Several o f the descriptions o f gifted w o m e n ' s experience o f disordered eating are not differentiated i n any way f rom the experience o f non-gifted ind iv idua l s noted i n the literature. Ga t to -Walden (1999) suggests that among the gifted clients s t ruggling w i t h disordered eating, several characteristics are c o m m o n . These characteristics inc lude : "Personal identity that has d i sowned be ing gifted, debi l i ta t ing perfect ionism, excessive need to please others, experience o f isolat ion and lonel iness, stressful transit ion dur ing the onset o f the disorder and f ami ly dynamics w h i c h m a y inc lude: overprotect ion, enmeshment, perfectionistic fami ly standards and abuse or addict ive behaviour" (p. 119). Garner (1991), an inf luent ial researcher and author i n the f i e ld o f disordered eating, addresses the "nature and scope o f the p r o b l e m " o f disordered eating among gifted adolescents. H e asserts that gifted adolescents "may be more vulnerable to the development o f both anorexia nervosa and b u l i m i a nervosa because [they] possess many traits that have 26 been ident i f ied as r isk factors for eating disorders" (p. '61). Garner suggests that "potential predisposing factors...seem part icular ly relevant to those w h o may be ident i f ied as gifted, (p. 52) Garner describes possible factors inf luencing the development o f disordered eating among gifted adolescents as compet i t ive settings, weight loss as "another area for d i sp l ay ing personal competence", l o w self esteem, perfect ionism and educational programs w h i c h focus on performance, personal mastery, and vocat ion , poss ib ly neglect ing other important areas o f female p sycho log i ca l development (p. 53). L e r o u x and Cuffaro (2001) explore the relat ionship o f h igh academic abi l i ty to eating disorders among adolescent females. A l t h o u g h the focus o f this article showed promise for a strong contr ibut ion to relevant research pertaining to this study, many o f the references used to draw out the relevant factors are not research-based or academic i n nature. Severa l o f the academic sources referred to appear to have been publ i shed over 10 years ago, w h i c h m a y result i n outdated informat ion. Despi te the weakness o f the sources ci ted, several relevant factors that apply to both ind iv idua ls who experience eating disorders and those w h o are h igh i n academic abi l i ty are identif ied. Factors that may intersect both eating disorder experience and h igh abi l i ty as suggested by L e r o u x and Cuffaro (2001) include: hypersensi t ivi ty; persistence; perfect ionism, h igh achievement, orientation/expectations; an introspective and intui t ive nature; intensity, exci tabi l i ty , impuls iveness ; competi t iveness; h igh I Q ; academic excel lence; conscientiousness; precocious behaviours and hypermaturi ty (p. 113). T h e article concludes w i t h recommendat ions for h o w to address prevention strategies for eating disorders, al though no recommendations appear to take into account any o f the factors that were out l ined as app ly ing to both eating disorders and h igh abi l i ty female adolescents. 27 Intellectual and Cognitive Ability Related to Eating Disorders C l i n i c a l impressions o f adolescents w h o experience disordered eating often refer to the h igh academic achievement and intel lectual abil i t ies o f these young w o m e n , yet research i n this area has fa i led to support these c la ims i n many instances (B lanz , Detzner , L a y , Rose & Schmid t , 1997; Ranseen & Humphr ies , 1992). B l a n z , Detzner , L a y , Rose and Schmid t (1997) investigated the intel lectual funct ioning o f a large sample o f eating disorder patients us ing a compar i son group w h o experienced other psycho log ica l disorders. A n overv iew o f other studies that invest igated ful l-scale I Q measures i n eating disorder patients publ i shed between 1976 and 1992 was presented. T h e heterogeneous f indings and methodologica l weaknesses i n previous studies were addressed. In this study the mean age o f the eating disorder sample was 15.4 and inc luded 190 out-patients and inpatients w i t h a diagnosis o f B u l i m i a N e r v o s a or A n o r e x i a N e r v o s a between 1976 and 1993. The compar ison group shared characteristics o f age, sex, soc ioeconomic status, and years o f admiss ion. N o communi ty control group was considered. Resul ts o f the study found that the " I Q of eating disorder patients was s igni f icant ly h igher that the compar i son group" (p. 129). A posi t ive correlat ion, w h i c h was weak but s ignif icant , was found between weight loss before hospi ta l izat ion and intel l igence. T h e authors suggest that there m a y be a relat ionship between h igh intel l igence, achievement mot iva t ion and abi l i ty to successfully lose weight. It is suggested that further studies are necessary to investigate that relat ionship (B lanz et a l . , 1997). Ranseen and Humphr i e s (1992) investigated the assumptions proposed by previous research and c l i n i c a l evidence addressing whether eating disorder patients have (1) above average intel lectual sk i l l s and (2) strengths i n verbal abil i t ies. I Q scores for the sample were 28 der ived f rom standard intel l igence tests (age appropriate W I S C - R and W A I S - R ) . T h e mean age o f the participants was 21.5 and the sample inc luded 100 female patients at an eat ing disorder inpatient unit. N o compar ison group was u t i l i zed in this study. A l t h o u g h a range i n intel lectual funct ioning among the sample was found, general intel lectual funct ioning was found to " rough ly con fo rm to the populat ion at large" (p. 845). S imi la r i t i es i n I Q scores between participants who experienced A n o r e x i a Nervosa , B u l i m i a N e r v o s a and E a t i n g Disorders Otherwise Spec i f ied were also found. G i l l b e r g , G i l l b e r g , Ras tam and Johannson (1996) make reference to D a i l y ' s (1969) study w h i c h reported f indings o f I Q scores ranging f rom 115-138 o f a selected group o f A n o r e x i a N e r v o s a patients. T h e lack o f current, methodolog ica l ly sound research w h i c h investigates the neuropsychologica l aspects o f A n o r e x i a N e r v o s a patients is c r i t i c i zed . G i l l b e r g , G i l l b e r g , Ras t am and Johansson (1996) examined a communi ty -based sample o f participants diagnosed w i t h A n o r e x i a N e r v o s a w i t h onset i n adolescence approximate ly 5 years after in i t i a l diagnosis and 6-7 years after onset (n=51). Fewer than 10% o f the eat ing disorder sample were be low average weight at the t ime o f testing. A n age, sex and schoo l matched compar i son group (n=51, mean age 21) was u t i l i zed and comparisons on the W A I S -R intel l igence test were considered. Fu l l - sca le I Q scores were not found to be higher i n the A n o r e x i a N e r v o s a group, d i d not differ s ignif icant ly f rom the compar i son group and were found to be c lose to the n o r m among the general popula t ion. D u r a and Borns te in (1989) examined the relationship between school achievement and I Q i n a sample o f adolescents diagnosed wi th A n o r e x i a N e r v o s a (mean age= 14.7, n=20). N o compar i son group was considered in this study. D u r a and Borns te in hypothes ized that based on "perfectionist ic standards" o f the sample, school achievement m a y be greater than 29 w o u l d be expected based on measures o f intel l igence. A g e appropriate standardized intel l igence tests ( W I S C - R / W A I S - R ) and measures o f achievement ( W R A T ) were used to explore this hypothesis. Fu l l - sca le I Q scores o f the sample ranged f rom 79-129 w i t h a mean o f 102.45. Resul ts support the in i t ia l hypothesis as achievement scores were reported to be s ignif icant ly higher than w o u l d be predicted by I Q scores. Garner (1991) also refers to several empi r i ca l studies examin ing the intel lectual funct ioning o f adolescents exper iencing eating disorders and comments on the lack o f consis tency among f indings. Studies that have reported deficits i n neuropsycholog ica l and intel l igence funct ioning (e.g. F o x , 1981; H o l l e m a n , 1985 as c i ted i n Garner) are referred to, as are contradictory f indings, w h i c h indicated above average funct ioning. D a l l y and G o m e z (1979) reported I Q scores o f 130 or greater among eating disorder patients w i t h onset between 11 and 14 years o f age. R o w l a n d (1970) reported an average I Q o f 113 i n a sample o f eating disorder patients w i t h one third o f the sample obtaining I Q scores greater than 120 (as c i ted i n Garner , 1991). R o w l a n d (1970) and T o u y z , Beumon t and Johnstone (1986) presents f indings s imi la r to D u r a and Borns te in (1989) suggesting that academic achievement and performance are higher than expected based on I Q measurements (as c i ted i n Garner , 1991). Garner (1991) refers to the possible ranges in intel lectual funct ioning among ind iv idua l s exper iencing eating disorders. Some young w o m e n exper ienc ing eating disorders may be ident i f ied as gifted based on school achievement, w h i c h may or may not be the result o f above average intel lectual funct ioning. Other young w o m e n m a y be " t ru ly in te l lec tual ly gif ted" and develop an eating disorder w h i c h "may relate to part icular r isks factors associated w i t h the giftedness or its ident i f icat ion" (p. 52). 30 Empirical Research Review of Giftedness and Psychological W7ell-Being Niehar t (1999) reviews the empi r i ca l literature pertaining to p sycho log ica l w e l l be ing among gifted ind iv idua l s . Niehar t highlights the prevalent controversy that exists i n current and h is tor ica l literature related to whether giftedness enhances p sycho log ica l res i l iency or increases vulnerabi l i ty . Niehar t reviews literature that speci f ica l ly addresses r i sk for maladjustment among gifted indiv iduals and global measures o f adjustment (e.g., c o p i n g , response to environment, personali ty). Giftedness and its relation to self-concept, depression, anxiety, suicide, socia l competence, deviant behaviour, and psychia t r ic disorders (eating disorders, m o o d disorders) are also addressed. Niehar t (1999) concludes that although this controversy continues, " i t is clear that giftedness influences the psycho log ica l funct ioning and we l l -be ing o f an i n d i v i d u a l " (Introduction section, \ 1). T h i s influence may have negative or posi t ive impl ica t ions for the i n d i v i d u a l and it is asserted that interacting factors such as the type o f giftedness, the fit between the i nd iv idua l and their environment such as educational p rogram, and the i n d i v i d u a l ' s personal characteristics, may a l l determine unique characteristics o f p sycho log ica l adjustment among gifted ind iv idua ls . Self Esteem, Self-Concept, Emotional Resilience and Gifted Gal lagher (2003) refers to the conf l ic t ing v iewpoin ts regarding the soc ia l and emot iona l development o f gifted ind iv idua ls . These two v iews diverge on the topic o f whether giftedness protects f rom, or creates more r i sk for maladjustment. Ga l lagher provides no conc lus ion but suggests that giftedness does not render students i m m u n e to 31 maladjustment and indicates that reviews o f the literature generally suggest that on average there is l i t t le difference i n emot ional adjustment between gifted and non-gif ted populat ions. A s found i n many areas o f gifted literature, there remains a controversy between whether gifted adolescents experience s imi la r or lower self esteem and self-concept than non-gif ted peers. Niehar t (1999) provides an overv iew o f research i n this area and emphasizes the inconsis tency and lack o f consensus on measures o f self-concept or self-esteem among gifted ind iv idua l s . M o s t avai lable research suggests a lower self-esteem and self-concept among gifted populat ions although conf l ic t ing results exist (e.g. H o g e and R e n z u l l i , 1993). L e a - W o o d and C lun ie s -Ross (1995) refer to these controversial f indings related to self-esteem o f gifted versus non-gifted adolescents. The authors suggest that gifted gir ls m a y be considered "doub ly disadvantaged" because they are both gifted and female (Introduction Sect ion, f 1). A n Aus t ra l i an sample o f 158 adolescent girls i n years 7, 8 and 9 o f the post p r imary years part icipated in the study (81 gifted and 77 non-gifted). Self-esteem was measured us ing the Coopersmi th Sel f -Es teem Inventory (Coopersmi th , 1987 as c i ted i n L e a -W o o d & C lun i e s -Ross , 1995). Quantitative f indings o f this study suggest that gifted students i n the sample had both lower total self-esteem and social self-esteem scores when compared to the non-gifted group. K l i n e and Short (1991) conducted an empi r i ca l cross-sectional study to examine the socia l and emot ional changes o f gifted females throughout the school years. Subjects inc luded 89 gifted females (n=58 i n the 9 t h - 1 2 t h grade, n=15 i n the 5 t h - 8 t h grade, and n=16 i n the l s t - 4 t h grade). N o non-gifted compar ison group was considered i n this study. Part icipants were administered a 138-i tem questionnaire regarding social and emot ional aspects o f 32 development . F ind ings suggested that self-confidence and self-regard among gifted adolescents decreased s ignif icant ly through their school development, more so than non-gifted peers, and that levels o f perfect ionism, hopelessness and discouragement increase. K l e i n and Zehms (1996) investigated the self-concept o f in te l lec tual ly gifted gir ls i n grades 3, 5 and 8 us ing scores f rom the Piers-Harr is Se l f -Concept Scale (Piers, 1984 as c i ted i n K l e i n & Zehms) . T h e participants inc luded 104 gifted females and a compar i son group o f on ly 30 non-gif ted females. F ind ings showed that the total self-concept scores o f the gifted gir ls decreased s ignif icant ly between grades 3 and 8 and also between grades 5 and 8. T h e total self-concept scores o f the non-gifted compar i son group between grades 3 and 8 also dec l ined but no statistically significant difference was found between grade 5 and 8 for this group. It was also reported that among the gifted grade 8 sample, a more negative sense o f self i n relat ion to behaviour , status (intellectual and school) and popular i ty i n compar i son to the non-gifted group was found. A b l a r d (1997) administered the M u l t i d i m e n s i o n a l Se l f -Concept Scale (Bracken , 1992) and the Adjec t ive checkl is t (Gough & H e i l b r u n , 1983 as c i ted i n A b l a r d , 1997) to 147 academica l ly talented eighth grade students. The sample was chosen based on S A T math and verbal scores. M e a n scores for the participants were compared to the means o f a normat ive popula t ion o f adolescents. Results o f this study suggest that the academica l ly talented participants had a higher academic self-concept and s imi la r soc ia l self-concept scores when compared to the normative group o f h igh school students. A b l a r d (1997) suggests that the group difference regarding academic self-concept m a y reflect academic abi l i ty . Mode ra t e ly higher self-confidence scores were found among the academica l ly talented students. Female participants i n the academical ly talented group received higher 33 scores on the adjective checkl is t scales related to achievement, dominance and endurance. These scales related to h igh academic achievement among this group. ; The females i n the academica l ly talented group were also less l i k e l y to seek emotional support, sympathy f rom others, and to express inferiori ty and socia l impotence. H o g e and R e n z u l l i (1993) address the di f f icul ty i n def ining both self-concept and giftedness. Compar i sons o f gifted and average ch i ldren ' s self-concept were exp lored through meta-analyt ical methods. Poss ib le hypotheses related to whether gifted ch i ld ren m a y have higher or l ower self-concepts were proposed. The construct o f self-concept was further b roken d o w n to consider different types o f self-concept such as "g lobal /composi te , academic, soc ia l , behavior , and p h y s i c a l " (p. 452). F ind ings f rom the study indicate that when addressed as a s ingle construct, it appears that the self-concept o f gifted ch i ld ren is s l ight ly higher than non-gif ted chi ldren . H o g e and R e n z u l l i propose that more meaningful results are found when self-concept is broken d o w n to explore various forms o f self-concept. W h e n this is done, meta-analyt ical f indings suggest that gifted chi ldren have more pos i t ive academic and behaviora l self-concept and that global /composi te self-concept was re la t ively s imi l a r for gifted and non-gifted chi ldren , but no significant difference was found for phys i ca l and soc ia l self-concept. W h e n the effects o f gender and age were considered, no signif icant effects were found. H o g e and R e n z u l l i identify several factors that m a y compromise these research f indings , such as the smal l number o f studies inc luded in the meta-analysis, the variable definit ions o f both giftedness and self-concept, and the fact that the results f rom the various studies were also considerably variable. T h i s study does offer an important contr ibut ion i n that it emphasizes the various domains i n w h i c h self-concept may vary. 34 Perfectionism M a n y research contributions relate a higher incidence o f perfectionist ic tendencies among both gifted ind iv idua ls and ind iv idua ls w h o experience eating disorders ( A s h b y & K o t t m a n , 1998; Bake r , 1996; Bas t ian i , R a o , W e l t z i n & K a y e , 1995; Greenspan, 2000; Nugent , 2000; Parker & M i l l s , 1996; Schuler , 2000; Shafran & M a n s e l l 2001 ; S i l ve rman , 1999). Literature pertaining to perfect ionism among gifted ind iv idua ls and ind iv idua l s exper ienc ing disordered eating m a y provide an important theoretical l i n k relat ing disordered eating and giftedness. L o C i e r o and A s h b y (2000) caution that definit ions and measurements o f perfec t ionism vary s ignif icant ly i n the literature. Perfectionism and Eating Disorders Shafran and M a n s e l l (2001) provide a literature rev iew o f perfect ionism and psychopathology. T h e concept o f perfect ionism is reviewed, c r i t ic i sms o f ex is t ing measures o f perfect ionism are presented and "h igh personal standards" and perfect ionism, par t icular ly among ind iv idua l s exper iencing disordered eating are emphasized based on the rev iew o f current literature. Different ia t ion between "pos i t ive" and "negat ive" perfec t ionism are considered, and these concepts are related to both healthy and unhealthy perfect ionism, as w e l l as no rma l and neurotic perfect ionism. Shafran and M a n s e l l (2001) assert that "eating disorders have l o n g been associated wi th perfect ionism both f rom a theoretical perspective and f rom a phenomenologica l one" (p. 889). Shafran and M a n s e l l (2001) cite research indica t ing perfect ionism as an ident i f ied r isk factor for ind iv idua ls w i t h A n o r e x i a Nervosa , B u l i m i a N e r v o s a and B i n g e E a t i n g disorder (Fairburn et a l . , 1998; Fai rburn , Cooper , D o l l & W e l c h , 1999 as c i ted i n Shafran & 35 M a n s e l l , 2001). Slade (1982 as c i ted in Shafran & M a n s e l l , 2001) suggests that perfect ionism is a "necessary cond i t ion" for A n o r e x i a N e r v o s a to develop. V i t o u s e k and M a n k e (1995 as c i ted i n Shafran & M a n s e l l , 2001) consider perfect ionism to be part o f the phenomenology o f A n o r e x i a . Bas t in i , Rao , W e l t z i n , and K a y e (1995) and Slade and D e w e y (1986 as c i ted in Shafran and M a n s e l l , 2001) found that ind iv idua ls w i t h A n o r e x i a , scored higher on measures o f perfect ionism compared to controls. Bas t i an i , R a o , W e l t z i n , and K a y e (1995) report h igh scores on measures o f perfect ionism among malnour ished, underweight ind iv iduals exper ienc ing A n o r e x i a Nervosa . T h i s perfect ionism is characterized as "se l f - imposed" and h igh scores on perfec t ionism measures are reported to persist after weight has been restored to appropriate levels i n these ind iv idua l s . It is suggested that h igh levels o f perfect ionism may have impl ica t ions for resistance to treatment and relapse among ind iv idua ls exper iencing A n o r e x i a Nervosa . A s h b y and K o t t m a n (1998) explored the relat ionship between adaptive and maladapt ive dimensions o f perfect ionism among ind iv idua ls exper iencing eating disorders. Ma ladap t ive perfect ionism is described by factors such as "overconcerns over mistakes, anxiety about performance, and procrast inat ion" (Discuss ion Sect ion, fl). A d a p t i v e perfect ionism is characterized by factors such as "h igh personal standards and need for order and organiza t ion" (Discuss ion Sect ion, fl). The i r f indings suggest that ind iv idua l s rece iv ing treatment for eating disorders scored s ignif icant ly higher on maladapt ive perfect ionism, but not on measures o f adaptive perfect ionism. Ma ladap t ive perfec t ionism is also reported to correlate w i t h "elevated levels o f body dissatisfaction, feelings o f 36 ineffectiveness, d i f f icul ty responding to emotions and perfec t ionism" on subscales o f the E a t i n g D i so rde r Inventory ( A s h b y & Ko t tman , 1998, D i scus s ion Sect ion, f 2). Perfectionism Among Gifted Controversy surrounding perfect ionism and its manifestations among gifted ind iv idua l s persists i n current literature. Perfec t ionism has been associated as a characteristic o f gifted ind iv idua l s , al though little empi r ica l literature supports higher inc idence or levels o f perfect ionism among gifted indiv iduals exists (Parker & M i l l s , 1996). S i l v e r m a n (1999), Nugen t (2000), and Schuler (2000) a l l address the predominance o f perfectionist ic tendencies and negative manifestations o f perfect ionism among gifted ind iv idua ls . S i l v e r m a n (1999) suggests that perfect ionism is the "least appreciated facet o f giftedness", cites h o w perfect ionism is an " inevi table" aspect o f giftedness and "needs to be appreciated as a two-edged sword that has potential for p rope l l ing an ind iv idua l toward unparal le led greatness or p lummet ing one into despair" (p. 216). In reference to the general populat ion, and speci f ica l ly gifted ind iv idua l s , Greenspan (2000) characterizes "Hea l thy Per fec t ion ism" as an " o x y m o r o n " . Greenspan (2000) rev iews the literature o f "heal thy" perfect ionism and suggests that various authors have referred to a con t inuum o f perfect ionism without an adequate empi r i ca l or theoretical basis. S i l v e r m a n (1999) refers to several authors who have noted the l i n k between perfect ionism and giftedness and suggests that there exist both posi t ive and negative mot ivat ions and consequences o f perfect ionism. Anecdo ta l ly , S i l v e r m a n suggests, "Per fec t ion ism is an inevitable part o f the experience o f be ing gif ted" (p. 216). S i l v e r m a n emphasizes a need to v i e w perfect ionism as not necessarily maladapt ive or as a characteristic 37 that needs to be "cured" , although the v i e w that perfect ionism is a " two-edged s w o r d " is mainta ined (p. 216). Per fec t ionism among gifted ind iv idua ls is seen as relat ing to asynchronous or uneven development, setting higher standards than peers, greater abi l i ty to predict the consequences o f behaviour, l ack o f challenge in school environments , and a d r i v i n g force for higher levels o f development (S i lverman , 1999). Nugen t (2000) suggests that gifted indiv iduals are more susceptible to perfect ionist ic tendencies than the general populat ion. Negat ive manifestations o f per fec t ionism such as eating disorders, depression, underachievement, and substance abuse are noted. G i f t ed students' "heightened sensit ivit ies, awareness and abi l i t ies" are addressed as important considerations i n counse l l ing gifted students (Introduction section, 11). V a r i o u s interventions to encourage gifted indiv iduals to "break the cyc le o f d i sab l ing per fec t ion ism" are suggested (Abstract section , % 1). L i t t l e evidence is provided , however , to support the negative manifestations o f perfect ionism among gifted ind iv idua ls , or to suggest interventions. Schuler (2000) examined the relationship between perfect ionism and giftedness among adolescents us ing both quantitative and qualitative data. Participants i n this study (n=l 12) were students i n grades 7 and 8 identif ied as gifted adolescents. A n operational def in i t ion o f "gifted adolescent" is not clear and no control group was considered. T h e G o a l and W o r k Habi t s Scale (Schuler, 1994) and a modi f i ed vers ion o f the M u l t i d i m e n s i o n a l Per fec t ion ism Scale (Frost, Mar t en , Lahart & Rosenblate, 1990 as c i ted i n Schuler , 2000) were administered to identify "perfectionistic adolescents". Schuler (2000) asserts that perfect ionism exists on a con t inuum o f normal to neurotic and presents f indings that characterize 12.5 % o f the sample as non-perfectionist ic, 58 .0% as normal perfectionists, and 38 2 9 . 5 % as neurotic perfectionists. Further qualitative data were obtained f rom 20 participants chosen f rom the normal and neurotic perfectionist categories. It is suggested that the "normal perfectionists" i n the sample "d isp lay self acceptance o f mistakes, possess an intense need for order and had pos i t ive role models for do ing one's personal best" (Discuss ion and Impl ica t ions section, f 2). T h e "neurotic perfectionists" are characterized as hav ing a "constant need for approval , extremely h igh standards and were in a seemingly constant state of anx ie ty . . . appear to l i ve i n an emotional environment o f condi t ional approval , . . . l a c k effective c o p i n g strategies and had few posi t ive role models on h o w to deal w i t h fa i lure" (Discuss ion and Impl ica t ions section, f 2). . L o C i e r o and A s h b y (2000) investigated the levels o f adaptive and maladapt ive perfect ionism i n 83 gifted students, grade 6-8, compared to 112 peers i n a general cohort . A d a p t i v e perfect ionism is described by factors such as ho ld ing h igh personal standards and maladapt ive perfect ionism is described by factors such as increased distress by discrepancy between h igh personal standards and performance. Quantitative f indings based on the A l m o s t Perfect Scale R e v i s e d (Slaney, et a l , 1996 as ci ted i n L o C i e r o & A s h b y , 2000) , suggest that gifted students are more perfectionistic than the compar i son group but that the gifted students do not score higher on measures o f maladaptive perfect ionism. B a k e r (1996) investigated the everyday stressors o f academica l ly gifted adolescents, both "gi f ted" and "except ional ly gifted" students, i n compar ison to academica l ly average students. A total o f 146 subjects i n grades 9 to 11 (n=56 average academica l ly average students, n= 58 gifted students and n=32 except ional ly gifted students) part icipated i n measures o f hassles, stressors and psychosocia l stressors. The areas measured by the psychosoc ia l stressor subscale were based on a literature relevant to giftedness and measured 39 stress related to fee l ing different, boredom, sensit ivi ty, perfect ionism and voca t ion . B a k e r (1996) found few differences among the groups related to the levels Of stress experienced, w i th the except ion o f scores on the perfect ionism subscales o f the psychosoc ia l stressors measure. O n the perfect ionism subscale except ional ly gifted gir ls reported stat ist ically significant higher levels o f perfect ionism than girls i n the academical ly average group. There was also a trend for the except ional ly gifted female group to experience higher levels o f perfect ionism than the gifted female group, al though this was not found to be statist ically significant. Scores o f perfect ionism were higher among each group for female versus male subjects. Parker and M i l l s (1996) investigated the incidence o f perfect ionism among 600 grade six students ident i f ied as "academica l ly talented" i n compar ison to a group o f 418 peers f rom a general cohort w i t h s imi la r soc ioeconomic status us ing the M u l t i d i m e n s i o n a l Per fec t ion i sm Scale (Frost, M a r t e n , Lahar t & Rosenblate, 1990 as c i ted i n Parker and M i l l s , 1996). Parker and M i l l s (1996) challenge the not ion that a higher incidence o f perfect ionism exists among gifted students based on empi r i ca l f indings rather than based on anecdotal reports. Quanti tat ive f indings suggest that the mean scores o f the two groups were s imi l a r and no statistical difference between perfectionistic types between the two groups was found. Parker and M i l l s (1996) assert that anecdotal reports suggesting h igh rates o f perfect ionism and more maladapt ive perfectionist ic tendencies among gifted students m a y be the result o f differential l abe l ing o f s imi la r behaviour based on preconceived assumptions. 4 0 Qualitative Research in the Giftedness and Eating Disorder Fields Literature relating to disordered eating, giftedness, and counse l l ing address the need for quali tat ive data to provide the leve l o f depth and meaning associated wi th understanding l i v e d experience (Garrett, 1997; H o s k i n s , 2002; K u n k e l & Chapa , 1992; M a t o f f & Mato f f , 2001) . The experience o f an eating disorder is not w e l l documented i n quali tat ive literature, al though many quali tat ive studies examine related experiences, such as those o f parents or health care providers w h o care for those w h o experience an eating disorder (e.g. Jarman, S m i t h & W a l s h , 1997; H o s k i n & L a m , 2001). Speci f ic to those w h o do struggle w i t h eating disorders, quali tat ive studies examin ing the experience o f b inge ing and purg ing or recovery are more c o m m o n (e.g. Garrett, 1997; M a t o f f & Matof f , 2001 ; Pettersen & Rosenv inge , 2002) . F e w publ i shed studies are specific to answering the questions: what is the l i v e d experience o f an eating disorder and what is the meaning o f that experience? There also appears to be a scarcity i n studies referring to the l i v e d experience o f gifted ind iv idua l s or w h i c h explore giftedness or related topics through qualitative means. F e w studies i n gifted literature address psycho log ica l funct ioning or distress among gifted adolescents us ing quali tat ive methodology. Qualitative Gifted Research T h e experience o f giftedness i tself and depression among gifted adolescents has been researched us ing phenomenologica l methodology (Jackson, 1998; K u n k e l & C h a p a 1992; K u n k e l , Chapa , Patterson & W a l l i n g , 1995). K u n k e l and C h a p a (1992) describe the experience o f giftedness among 85 seventh, eighth and ninth grade adolescents par t ic ipat ing i n a gifted summer enrichment program. K u n k e l and C h a p a comment on the rari ty o f 41 research that has "sought to understand and appreciate giftedness as an internal ly exper ienced phenomenon" . T h e need to focus on the construct o f giftedness as a gifted popula t ion experiences it, rather than as researchers define it, is emphasised (Introduction section, f 2). Ga lb ra i th (1985) conducted a study entitled, "The eight great gripes o f gifted k id s " , w h i c h provides a foundation for K u n k e l and Chapa ' s research (as ci ted i n K u n k e l & Chapa , 1992). Ga lb ra i th (1985) p rov ided li t t le information regarding methodology used i n in terviews and surveys w i t h over 400 gifted chi ldren and adolescents, ages 7-18 i n gifted p rogram throughout the U n i t e d States. K u n k e l and C h a p a (1992), asked participants to respond i n w r i t i n g to a neutral probe " W h a t is it l i k e to be gifted?" Responses were analyzed in relation to Ga lbra i th ' s o r ig ina l themes w h i c h inc luded: confusion, boredom, perfection, r id icule , loneliness, uniqueness, burdened and altruistic. Wi thou t probing i n relation to specific aspects o f the gifted experience, more than ha l f o f the sample noted confusion about giftedness and its mean ing i n their l ives . T h i s was seen as an over r id ing theme i n their responses. Frustrat ion w i t h the expectations o f others and w i t h a need for perfection was reported by one th i rd o f the sample. A l t r u i s m , concerns about the wor ld ' s problems, boredom and feelings o f be ing ove rwhe lmed were reported less frequently without speci f ica l ly be ing addressed than w o u l d be suggested by Galbra i th ' s f indings. Shame and isola t ion were addit ional themes developed f rom the student responses that were not referred to i n Galbra i th ' s o r ig ina l study. K u n k e l , Chapa , Patterson and W a l l i n g (1995) expand on the w o r k presented by K u n k e l and C h a p a (1992) by developing a concept map o f the experience o f giftedness based on the same data. T h e same participants were asked to contribute to a conceptual map us ing responses generated f rom the or ig ina l writ ten response to the probe " W h a t is it l i ke to be 42 gif ted?" N i n e t y - s i x meaning units were arranged i n clusters through card sort by participants and f rom concept mapp ing procedures. The clusters inc luded: intel lectual superiori ty, soc ia l superiori ty, self-satisfaction, ski l l fulness, respect f rom others, socia l stress, estrangement, and conformi ty . Jackson (1998) investigated the l i v e d experience o f depression among a sample o f gifted adolescents. The p rob lem o f interest is defined as want ing to document "the scope and nature o f the depressive experience" among gifted adolescents, and to address impl ica t ions for practice (Introduction section, 16). Increased rates o f suicide and increased r isk o f depression are c i ted and provide a strong rationale and basis for this study. A l t h o u g h not e x p l i c i t l y stated, the i m p l i c i t research questions can be seen as h o w the l i v e d experience o f depression is manifested among this populat ion, and whether the l i v e d experience is qual i ta t ively different f r o m the norm. A phenomenologica l inqui ry revealed the "essence" o f the core structure and l i v e d experience o f depression among this popula t ion i n a sample o f 10 participants ages 16-19. I Q scores served as a m i n i m u m requirement for par t ic ipat ion yet other relevant factors such as abi l i ty to articulate the experience and emot iona l intensity were considered. T h e participants were self-referred as hav ing experienced depression, yet the l eve l o f severity and duration var ied s ignif icant ly among the participants. One question was asked i n the beginning o f the in terview, "Please describe for me your experience w i t h the less than posi t ive emot ional state c o m m o n l y k n o w n as depression". T h e participants were g iven the opportunity to te l l their stories and the phenomenon was " a l l o w e d to speak for i t s e l f (f 1, Da ta Sources Section). The results o f this study suggest that the depressive experience o f this populat ion i n v o l v e d the in i t ia l stage o f the depressive state, the state i tself and the impact . Core themes identif ied through Jackson ' s analysis were 43 that emot ion and affect are central to the experience o f the gifted adolescent, and that these needs inc lude the need for knowledge , c o m m u n i o n and expression. These themes prov ide a significant l eve l o f insight into the funct ioning, development and needs o f the gifted adolescent. Jackson and Peterson (2003) examine the "nature and extent" o f depressive disorders as they related to h igh ly gifted adolescents through the use o f phenomenolog ica l analysis , focus group and c l i n i c a l data (p. 175). It is argued that this populat ion frequently masks depression f rom others, and that unique qualitative differences o f the experience o f depression and contr ibut ing may occur. T h e ut i l i ty o f quantitative measures to determine genuine depressive disorders among h igh ly gifted adolescents is questioned. A rev iew o f general literature on depressive disorders, literature and c l i n i c a l evidence related to depression among h igh ly gifted adolescents, outl ine o f c o m m o n traits among gifted adolescent populat ions and case studies, and results o f a phenomenologica l inqu i ry are presented. Suscept ib i l i ty to depression is seen as relating to "poorness o f f i t " i n their environment and among peers. Soc io-emot iona l and intellectual needs m a y not be "mir rored" , or their perceptions o f the w o r l d may not fit w i th those around them (p. 178). Heightened sensi t ivi ty and mask ing o f depressive symptoms or under ly ing fee l ing are related to feelings o f shame and a fear o f how others may be affected by their expression o f depression. Qualitative Research on Eating Disorders Despi te the va s tnumber o f articles that address eating disorders in the literature, few studies refer to the l i v e d experience o f eating disorders f rom the perspective o f the 44 ind iv idua l s exper iencing the phenomenon. The experience o f eating disorder recovery appears to have rece ived some attention i n recent literature (e.g. Garrett, 1997; M a t o f f & Matof f , 2001 ; Pettersen & Rosenvinge , 2002) although the experience o f disordered eating i tself is not addressed speci f ica l ly through publ i shed qualitative research. M a n y studies refer to the need for quali tat ive research that can speak more fu l ly to the human experience rather than r i sk factors, e t io logy or treatment outcomes related to disordered eating (e.g., H o s k i n s , . 2002; M a t o f f & Matof f , 2001). Ea t ing disorders present a significant struggle and process for ind iv idua l s w h o experience them, and the informat ion and sharing that can be ga ined f rom these ind iv idua l s about their human experience should not be over looked , nor its power underestimated. Garrett (1997) refers to the many aspects o f the experience o f eating disorders that cannot be, or are not, thoroughly examined through quantitative means, and argues that there exists a lack o f indicators o f posi t ive outcomes and recovery i n current research. It is suggested that these indicators o f recovery may o n l y be e l ic i ted by the stories o f those exper iencing and recover ing f rom eating disorders. Garrett investigated the stories o f recovery o f 32 female participants w h o were i n various stages o f recovery f rom A n o r e x i a , us ing phenomenolog ica l methodology f rom a soc io log ica l perspective. Cer ta in elements associated w i t h recovery among the participants inc luded 1) abandoning obsession w i t h food and weight , concomitant w i t h a cr i t ica l understanding o f socia l pressure, 2) hav ing a sense that their l ives were meaningful , 3) be l i ev ing that they were wor thwhi le , and that the different aspects o f themselves were part o f a who le person, 4) be l i ev ing strongly that they w o u l d never return to self-starvation and 5) ment ioning spir i tual i ty as a source o f meaning . 45 M a t o f f and M a t o f f (2001) assert that the process and experience o f disordered eating and recovery f rom a c l ien t ' s account "has potential to be a r ich source o f untapped i n f o r m a t i o n . . . " w h i c h m a y contribute to greater understanding and have impl ica t ions for treatment (p. 44) . B a s e d on qualitative data obtained through a structured, open-ended in terview, the experience o f recovery for one participant diagnosed w i t h A n o r e x i a N e r v o s a (binge/purging type) was explored. Detai ls o f data analysis are not p rov ided , al though c o p i n g strategies, stages and elements o f recovery such as "seeking professional help, avo id ing destructive relationships and gaining empowerment to battle the relentless inner cr i t ic that overshadows da i ly l i f e " are described (p. 47) . W i c k s t e e d (2002) explores issues related to control i n those w h o experience eat ing disorders through a quali tat ive approach. W i c k s t e e d suggests that al though seeking cont ro l is often a prevalent theme i n the experience o f disordered eating it has on ly "deve loped anecdotal l i nkage" (p. 475) . , A s part o f a p i lo t study i n v o l v i n g 32 ind iv idua l s , ages 14-56, e m p l o y i n g quali tat ive analysis o f data contained through emai l contact, two m a i n themes were elucidated. A l t h o u g h the methodology used to garner these themes is not w e l l articulated emerging themes included: 1) "various contexts i n w h i c h the ind iv idua l s had l i m i t e d control /autonomy over l i f e " , such as personal traumas, l o w self esteem and se l f wor th associated w i t h the needs and perceptions o f others and 2) "unpredictabi l i ty o f contextual situations compared wi th the predictabi l i ty o f f ood" both as related to autonomy or seeking control and for comfort (p. 478). 46 The Literature Reviewed as it Relates to the Current Study The literature reviewed forms the basis of this study, the research questions, and methodology used. Although, the lack of consensus on a concrete definition or understanding of giftedness complicates this research project, the literature reviewed provides a basis for considering current conceptualizations of giftedness and commonly associated characteristics. The suggestion that qualitative research can add much to the current understanding of gifted individuals also contributes to the study's rationale and chosen methodology (e.g., Coleman & Cross, 2000; Jackson & Peterson, 2003). The lack of specific literature that relates to gifted individuals who experience eating disorders, and the absence of research studies that address this topic, represents a gap in the current state of knowledge. Inferences were drawn from the reviewed literature in both the fields of giftedness and eating disorders to identify characteristics and risk factors that intersect both areas. The areas of self-esteem, self-concept, and perfectionism were highlighted as particularly salient themes in both gifted and eating disorder literature. These characteristics and literature that relates to adolescents, and more specifically to gifted adolescents who experience eating disorders, provide a foundation to discuss the findings that emerged from this study. Several researchers in both giftedness and eating disorders address the need for qualitative research to further explore the subjective understanding of those who live these experiences. Qualitative research related to gifted individuals, both in general and in studies specific to depression, provides both insight and the depth of understanding similar to which the current study aspires. Qualitative research related to eating disorders currently lacks contributions that reveal what the experience of an eating disorder is like for those who 47 experience it from a subjective perspective. The combination of all of these factors prompted me to explore qualitatively the experience of eating disorders among gifted adolescents, and the meaning that is ascribed to that experience. 48 C H A P T E R III Methodology Phenomenology requires a k i n d o f wi thdrawal f rom the w o r l d , and a wi l l ingness to lay aside exis t ing beliefs and theories. Th i s is r i sky, and takes an act o f courage. It can be v i e w e d as a journey dur ing w h i c h one leaves fami l ia r places and then returns and sees these places i n a fresh l ight . ( M c L e o d , 2001 , p. 37) T h e method o f inqu i ry used for this study is descript ive, phenomenolog ica l and based w i t h i n a quali tat ive paradigm. Th i s research design was chosen for the u t i l i ty i n addressing the core and c o m m o n themes o f the l i v e d experience o f the phenomenon o f interest. A phenomenologica l study provides the opportunity to explore the research questions at the depth and l eve l o f meaning, through w h i c h I hoped to describe the experience o f eating disorders among gifted adolescents. C o l e m a n and Cross (2000) speci f ica l ly c a l l for research addressing the l i v e d experience o f gifted ind iv idua ls , and cite phenomenology as a valuable method to explore giftedness, the socio-emotional aspects o f gifted ind iv idua l s ' experience, and the meaning o f that experience. T h e present study explores and describes qual i ta t ively the experience o f an eating disorder amOng a sample o f gifted female adolescents. S i x young w o m e n part icipated i n phenomenolog ica l interviews through w h i c h they described their personal experience o f an eating disorder. T h e interviews were subsequently transcribed and analyzed, revea l ing ten themes descr ib ing the participants ' experience and their associated meaning . E a c h theme and its associated sub-themes were elaborated on and supported through th ick descr ipt ion and in terview excerpts i n the presentation o f the research f indings. 49 Research Questions The research questions that guided this study were designed to effectively address its purpose and rationale. These research questions included: • What is the lived experience and meaning of disordered eating among gifted female adolescents? • What are the core and common themes, or the essence of the experience of an eating disorder, among the participants? • What aspects of giftedness are represented in the lived experience of disordered eating among gifted adolescents? Definitions Both the major constructs referred to in this study, "eating disorder" and "gifted", are difficult to define precisely. Operational definitions used throughout this study include: Gifted Adolescent: An individual age 15-18 who manifests heightened cognitive and emotional functioning as measured by IQ tests and/or anecdotal reports from trained and experienced professionals who specialize in either the gifted or eating disorders field. Gifted adolescent may also be defined as an adolescent age 15-18 who has been defined by the educational system as gifted as per the B.C. Ministry of Education guidelines (2002) for definition, identification and assessment of gifted students. The B.C Ministry of Education guidelines consider a student gifted when "she/he possesses demonstrated or potential abilities that give evidence of exceptionally high capability with respect to intellect, 50 creat ivi ty or the sk i l l s associated wi th specific d isc ip l ines . Students w h o are gifted often demonstrate outstanding abil i t ies i n more than one area. T h e y may demonstrate extraordinary intensity o f focus in their particular areas o f talent or interest" (Def in i t ion Sec t ion , f 1). Giftedness: "Asynch ronous development i n w h i c h advanced cogni t ive abi l i t ies and heightened intensity combine to create inner experiences and awareness that are qual i ta t ively different f rom the no rm. T h i s asynchrony increases wi th higher intel lectual capaci ty" ( C o l u m b u s G r o u p , 1991 as ci ted i n Jackson, 1995; S i lve rman , 1998, Def in i t ions o f Giftedness Sect ion, <j[ 4). Giftedness also includes "demonstrated or potential abi l i t ies that give evidence o f except ional ly h igh capabi l i ty w i th respect to intellect, creat ivi ty or the sk i l l s associated wi th specif ic d i sc ip l ines" ( B . C M i n i s t r y o f Educa t ion , 2002, D e f i n i t i o n Sec t ion , <J[ Eating Disorder: De f ined by cri ter ia for A n o r e x i a Nervosa , B u l i m i a N e r v o s a or Ea t i ng D i so rde r N o t Otherwise Speci f ied i n the D S M - I V - R ( A P A , 2000) . Please see A p p e n d i x A for diagnostic cr i ter ia o f A n o r e x i a Nervosa , B u l i m i a Ne rvosa , and E a t i n g Disorder N o t Otherwise specified. Descriptive Phenomenology as a Method G i o r g i (1985) refers to the o r ig ina l wri t ings o f Husse r l (1970/1900), noted as the "founder o f phenomenology" , to describe the "gu id ing theme" o f phenomenology as go ing 'back to the things themselves ' (p. 8). Descr ip t ive phenomenologica l methods such as those described by G i o r g i (1985, 1997), G i o r g i and G i o r g i (2003) and K a r l s s o n (1993) seek to i l lumina te the essential structure or essence o f a phenomenon and the mean ing that is 51 ascribed to the phenomenon by the participants. The essence o f a g iven phenomenon presented is descript ive, qualitative and answers the questions o f "what" and " h o w " rather than " w h y " (Kar l s son , 1993). G i o r g i (1992) responds to concern that descriptive phenomenology is not able to address the meaning structure o f phenomenon. G i o r g i suggests that by a l l o w i n g the phenomenon to be described as it presents i tself f rom the participants, this "d i scovery or iented" perspective w i l l a l low meaning to emerge. Descr ip t ions themselves are seen as " loaded w i t h concrete expressions o f mean ing" (p. 124). G i o r g i argues that descr ipt ive phenomenology involves the "c lar i f ica t ion o f meaning o f objects precisely as they are exper ienced" and that it is not necessary to go beyond the descriptions to bestow mean ing w h i c h may invo lve the domain o f interpretive phenomenology (p. 122). H e argues that part icipants ' interpretation o f their experience does not have to be interpreted to have meaning and can instead be described. Desc r ib ing the part icipant 's awareness o f the meaning is seen as important as a search for a un ivoca l meaning interpreted by the researcher that may occur i f we seek to move beyond what the data present. K a r l s s o n (1993) outlines his empi r i ca l , phenomenologica l , p sycho log ica l approach (EPP-method) w i t h both theoretical support and concrete i l lustrations o f the method. T h e steps o f the procedure are very s imi la r to those out l ined as descript ive phenomenolog ica l methodology by G i o r g i (1985), and G i o r g i and G i o r g i (2003). K a r l s s o n (1993) emphasizes the value o f " l i f e w o r l d experiences" and the need for r igorous methodology to uncover the 'essence' or 'meaning structure' o f the phenomenon o f interest (p. 45) . I have chosen descript ive phenomenologica l methods to a l l ow the part icipants ' data and the meaning they ascribe to their o w n l i v e d experiences to emerge as they present 52 themselves. I bel ieve that descript ion o f experiences is not without meaning and has significant value i n its o w n right. Phenomenological Interviewing M c L e o d (2001) suggest the phenomenologis t ' s task is " immense" and that tools avai lable are "our experience itself, and the language w h i c h has evo lved w i t h i n a culture to account for that experience" (p. 36). In response to c o m m o n objections and skep t ic i sm about the u t i l i ty or object ivi ty o f qualitative research in te rv iewing , K v a l e (1994) defines the purpose o f the quali tat ive interview as to "gather descriptions o f the l i f e - w o r l d o f the interviewee w i t h the intention o f interpreting the meaning o f the described phenomenon" (p. 149). K v a l e (1983) describes many o f the central aspects o f quali tat ive research in t e rv i ewing w h i c h relate to descript ive phenomenologica l research. A c c o r d i n g to K v a l e (1983), the subject matter o f the quali tat ive research in terv iew is the l i fe w o r l d o f the participant, and how he/she experiences it. The goal is to obtain as complete a descr ipt ion as possible o f the interviewee 's l i fe w o r l d or experience related to the phenomenon experienced. T h e purpose is to understand and describe the meaning o f core and c o m m o n themes i n the experience. The qualitative research in terview must a i m to be "presupposi t ionless" i n the sense that the interviewer must attend to the in terviewee 's experience w i t h openness and a "c r i t i ca l consciousness o f his o w n presupposi t ions" (p. 176). K v a l e also suggests that the qualitative research interview is an interpersonal interaction between two people and can be inf luenced by the sensit ivi ty o f the interviewer to the participant and subject matter. T h i s sensi t ivi ty may cause tension between the need to remain "presupposi t ionless" and the role o f the interviewer in obtaining an in-depth 53 descr ipt ion o f the part icipant 's experience. The requirement o f bracket ing and "deliberate conscious naivete" on the part o f the interviewer must be attended to (p. 178). Bracketing: Rationale and Procedure W h e n it is said that wi th in the reduction everything that presents i tself is to be accounted for precisely as it presents itself, it is strategy devised to counteract the potent ia l ly biased effects o f past experience. W h e n we encounter fami l i a r objects we tend to see them through famil iar eyes and thus often miss seeing nove l features o f fami l ia r s i tua t ions . . . .Even i f objects turn out to be precisely as we first thought, it is more rigorous to give nuances and ' taken for granted' aspects a chance to show themselves, because phenomenologists do want the totality to be accounted for. ( G i o r g i & G i o r g i , 2003 , p. 249) Suspending pr ior knowledge and beliefs related to the phenomenon o f interest, or bracket ing is a cha l lenging task and may i n fact represent an "act o f courage" as suggested b y M c L e o d (2001, p. 37). Despi te the challenges, and the need to engage w i t h the data i n this way , bracket ing remains an essential and necessary element o f phenomenolog ica l data analysis. A s h w o r t h (1996) refers to the his tor ical foundations and importance o f bracket ing to phenomenolog ica l research. The fact that phenomenologica l p sycho logy is a " rad ica l ly interpersonal process" is noted i n conjunction wi th the premise that bracket ing remains a c r i t i ca l and "indispensable methodologica l p r inc ip le" o f phenomenology (Introduction Sect ion , f 6). In as m u c h as it is possible, pr ior assumptions about the phenomenon must be 54 put aside to a l l ow the phenomenon to be described " i n its appearing" (Ashwor th , 1996, Introduction Sect ion, f 6). Anns toos (1985) suggests that bracket ing i n phenomenology does not represent a "disinterest o f the researcher" i n the participants ' l i v e d experience or the phenomenon but rather a suspension o f a l l o f interests, beliefs or preconce ived ideas o f the phenomenon. Th rough bracket ing the "danger o f f ind ing on ly what one expects to see" is lessened (p. 91). A s h w o r t h (1996) suggests that the cri ter ion o f bracket ing is: " i f the maintenance o f a g iven type o f assumption w o u l d subvert entry into the l i f e -wor ld , such presupposit ions must be set aside" (Conc lus ion Sect ion, fl). The diff icult ies and challenges o f meet ing this requirement are considered, yet guided by the rationale o f a l l o w i n g the c o m m u n i c a t i o n o f descriptions o f the phenomenon as the participants present them. Through declarat ion and self-reflection o f presupposit ions that existed for the researcher pr ior to the part icipants ' interviews, and those that emerged throughout the in terview and data analysis processes, those w h o interpret the f indings m a y judge for themselves h o w those presupposit ions inf luenced the presented f indings. G i o r g i and G i o r g i (2003) address the not ion o f bracket ing through considerat ion o f Husse r l ' s phenomenolog ica l reduction (1900/1970; 1913/1983 as c i ted i n G i o r g i & G i r o g i , 2003). T h e phenomenologica l reductions are described as an attitude rather than as a specif ic set o f procedures. T h e "great confus ion" related to this first step i n phenomenology appears to be reflected i n the lack o f c lar i ty surrounding it, and also controversy as to whether these reductions are possible (p. 245). G i o r g i and G i o r g i differentiate between scient if ic phenomenologica l reduct ion and transcendental phenomenologica l reduct ion, and suggest these two concepts contribute to the confusion surrounding reduction i n the Husse r l i an sense. 55 T h e y (2003) mainta in that transcendental is " w h o l l y ph i losoph ica l " , and that instead "psycho log i ca l subject ivi ty" is o f interest to, and should guide, p sycho log ica l analysis (p. 245). K a r l s s o n (1993) provides some clar i ty to the issues o f phenomenolog ica l p sycho log ica l reductions and transcendental reduction as referred to by Husse r l . B o t h phenomenolog ica l psycho log ica l and transcendental reduction are descr ibed as a "break w i t h our natural attitude" and a "non-reflective be l ie f i n the transcendental w o r l d " (Kar l s son , 1993, p. 48) . Transcendental reduction is more complex than psycho log ica l reduct ion and invo lves putt ing aside a l l be l ie f i n the transcendental w o r l d and its existence at a ph i losoph ica l l eve l (Kar l s son , 1993). G i o r g i and G i o r g i (2003) suggest that transcendental phenomenologica l reduct ion is less useful i n human sciences, and also suggest that it is the ut i l i ty o f scientif ic phenomenolog ica l reduct ion (which Husser l referred to as psycho log ica l reduction), that forms the basis o f bracket ing. Through scientif ic or psycho log ica l reductions, the things that present themselves through the participants ' experience are taken as they are. T h i s a l lows the phenomenologis t to see the totality o f the experience emerge ' f reshly ' and w i t h ' d i s c ip l i ned naivete ' rather than to see on ly what they thought w o u l d be seen ( G i o r g i & G i o r g i , 2003 , p. 249). K a r l s s o n (1993) also maintains that rather than "transcendental reduct ion", "part ial phenomenologica l reduct ions" (which G i o r g i refers to as the scientif ic phenomenolog ica l reduction), whereby the researcher brackets a l l "theories, hypotheses, models and systems" w h i c h m a y explore or seek to expla in the phenomenon o f study, has significant u t i l i ty (p. 80). T h i s l eve l o f reduction a l lows for the research to "bel ieve i n " the text i n order to analyze it, 56 and w h i l e not repressing or denying any pr ior knowledge or beliefs about the phenomenon, that knowledge or be l ie f is to be brought to a "thematic leve l in order to be authentical ly capable o f setting it aside" (p. 82). Bracketing of Researcher's Biases and Assumptions: Considerations of the Researcher as a Subjective Person M y role as a researcher was c lear ly stated pr ior to engaging i n the research interviews. Bracke t ing o f personal knowledge and beliefs regarding the phenomenon were attended to through analysis o f the experience o f the participants. W h i l e this can never be comple te ly achieved, expos ing these biases a l lows the reader o f the report to determine for h i m or herself how "pure" the answers to the questions asked are. That is , he or she can determine h o w m u c h they reflect the experience o f the participants rather than the beliefs o f the researcher (Cre swe l l , 1998; M a c l e o d , 2001). W h e n I began to engage i n the process o f in te rv iewing , I needed to be w i l l i n g and able to put aside what I may bel ieve to be relevant to the part icipants ' experience. A detai led f ie ld jou rna l was kept i n order to moni tor m y awareness throughout the in terview and analysis processes, and a process o f go ing back to this bracketed knowledge and feelings was a c ruc ia l aspect o f a l l o w i n g the data and the part icipant 's experience o f the data to " show i tself for the subject" (Kar l s son , 1993, p. 50). In an attempt to remain "presupposit ionless", I openly declared m y biases and subjective assumptions pr ior to engaging i n the interview and data analysis procedures. Throughout the in terview and data analysis, I cont inued to reflect back on those biases and assumptions through the reflective journa l . It d i d take courage to do so, as the fear o f f ind ing 57 on ly what I thought I might f ind was present i n m y consciousness. T h i s a l l owed me to be mind fu l and more r igorous throughout the process i n order to validate the f indings and to ensure that the results are true to the experience o f the participants. B a s e d on m y personal experience and subjective interpretations, rev iew o f the literature pertaining to disordered eating and giftedness, and professional exper ienc ing w o r k i n g w i t h adolescents (both gifted and non-gifted) who experience disordered eating, I ident i f ied several biases and assumptions that were carefully attended to and bracketed throughout data co l lec t ion and analysis. These presupposit ions inc luded the f o l l o w i n g : • A l t h o u g h weight and food preoccupations are often (though not a lways) predominant i n the experience o f disordered eating, under ly ing emot ional and p sycho log i ca l issues are central to the experience. • Aspects o f giftedness (e.g., asynchronous development, sensi t ivi ty to the expectations and needs o f other, h igh personal standards, perfect ionism, emot ional and intel lectual overexci tabi l i t ies) may be present i n the l i v e d experience o f gifted adolescents w h o experience disordered eating. • Adolescents , and poss ib ly to a greater extent gifted adolescents, w i l l be able to articulate the l i v e d experience o f disordered eating, whether currently exper ienc ing disordered eating or hav ing recently recovered. • A m o n g gifted adolescents, lack o f accurate mi r ro r ing o f emot ional intensity and awareness or intel lectual abi l i ty by peers or f ami ly may contribute to p sycho log i ca l vulnerabi l i t ies or distress. • D u r i n g adolescence, asynchronous development or be ing "out o f step" w i t h peers m a y be especia l ly salient and contribute to psycho log ica l vulnerabi l i t ies or distress. 58 • Many adolescents who experience disordered eating seem exceptionally bright and articulate, although a qualitative difference between the experience of disordered eating between gifted and non-gifted adolescents may exist. • In many instances, disordered eating is a coping mechanism through which adolescents manage psychological discomfort and pain. • Societal pressures and mixed messages (i.e. be powerful yet feminine) and family factors are involved in the development of disordered eating among gifted adolescent females. Recruitment Potential subjects were approached through a letter of recruitment which was forwarded to them from professional treatment providers with expertise in psychotherapy, eating disorder treatment, counselling or education of gifted individuals or individuals experiencing eating disorders (for example: B .C . Children's Hospital eating disorder program and local community eating disorder treatment programs). Potential subjects were not directly approached, and instead were provided access to contact information should they choose to inquire further. Professionals were contacted by phone and/or through letters of contact delivered by mail or in person from the student researcher. Letters of contact outlined the purpose and nature of the study, participation criteria, procedures to be used, and contact information to answer any questions. Posted advertisements and email messages indicating recruitment information were forwarded to organizations that the student researcher is aware of or has contact with such as B . C Children's Hospital Eating Disorders program, community outpatient child and youth 59 eating disorders programs, the Ea t ing Disorder Resource Centre o f B r i t i s h C o l u m b i a , the E m i l y C a r r Institute, the Gi f t ed Chi ldren 's Assoc i a t i on o f B . C . , the D a i m o n Institute for the H i g h l y Gi f ted , S i m o n Fraser U n i v e r s i t y ' s C o u n s e l l i n g Centre, and loca l c o m m u n i t y outpatient eating disorder treatment programs. W h e n potential participants made contact w i t h the student researcher i n response to a posted advertisement at eating disorder treatment faci l i t ies a letter o f contact was forwarded to them. Participant Selection Procedures T h e focus o f the study i n v o l v e d participants w h o had i n the past f ive years exper ienced or w h o currently experience an eating disorder as an adolescent (age 15-18). Part icipants were selected based on several cr i ter ia that inc luded each o f these considerations: • Females w h o have experienced/experience disordered eating between the ages o f 15 and 18. • T h e experience o f disordered eating has occurred wi th in the last 5 years. • H a v e received treatment or counse l l ing for Disordered Ea t ing . • Prev ious cogni t ive assessment y i e ld ing I Q above 130 and/or membership i n an educational gifted p rogram and/or the op in ion o f an expert professional that the participant meets cr i ter ia for giftedness out l ined i n the study. • W i l l i n g n e s s and abi l i ty to articulate their thoughts, perceptions and feelings about the experience o f disordered eating. • Free o f any phys io log ica l or psycho log ica l condi t ion that may s igni f icant ly affect their ab i l i ty to articulate their experience (i.e. severe malnut r i t ion or med ica l instabil i ty.) • A b l e to speak and understand E n g l i s h . 60 Participant Characteristics S i x gifted female adolescents who met the selection cri ter ia part icipated i n the in terv iew process. These s ix interviews formed the basis o f data that were analyzed, and the subsequent results. T w o other participants who d i d not meet a l l o f the select ion cr i ter ia due to not str ict ly meet ing the giftedness cri ter ia or age requirements, also part icipated as p i lo t in terview participants. These two indiv iduals were aware that that they d i d not fu l ly meet the requirements, yet inqu i red i f they were able to help at some leve l . These two in terviews were o f tremendous assistance i n gain ing comfort and s k i l l wi th the in terview pro toco l and phenomenologica l in te rv iewing . Part icipants had a l l received a diagnosis and been treated for A n o r e x i a N e r v o s a . T h i s represents an unexpected and interesting characteristic o f the sample, as the type o f eating disorder was not specif ied i n recruitment or selection o f participants. A l l participants continue to receive treatment and or support wi th their eating disorder or related psycho log ica l or adjustment issues. A l l but one o f the participants exp l i c i t l y noted that they continue to struggle w i t h eating disorder dynamics . The remain ing participant indicated that eating disorder dynamics are not far f rom her current experience and many o f the related under ly ing issues continue to be present in her current experience and are addressed i n her treatment. E a c h participant was between the ages o f 16 and 20 when in terv iewed, but had experienced A n o r e x i a between the ages o f 15-18. F i v e o f the s ix participants had been hospi ta l ized as a result o f their eating disorder, and all had experienced signif icant phys i ca l health r isk as a result o f their eating disorder. E a c h participant had spoken to their current mental health care providers pr ior to responding to either the recruitment poster or the letters 61 o f contact that were passed on to them by these professionals, and were supported i n part ic ipat ing i f they chose to. E a c h participant expressed a h igh l eve l o f enthusiasm for the focus o f the study and the personal, academic and c l i n i c a l value that it may offer. Severa l participants reflected throughout the recruitment, interview, and fo l l ow-up va l ida t ion process that their part icipat ion had also highl ighted for them how this aspect o f the eating disorder experience had been neglected to this point. C r i t e r i a for giftedness were p r imar i ly met through membership i n gifted and talented h igh school or early entry universi ty programs, typ ica l ly w i th a his tory o f several standardized testing experiences indica t ing giftedness. In other cases, meet ing giftedness cr i ter ia was based on the op in ion o f expert professionals, consider ing also col lateral evidence o f except ional abi l i ty i n one or more domains. In a l l cases, participants possessed evidence of except ional abi l i ty and achievement i n several domains inc lud ing athletic, creative, intrapersonal, and academic domains . Informed Consent F i v e o f the s ix participants were under the age o f 19 at the t ime o f the in te rv iew process, and were therefore legal ly considered minors . In each o f these instances a parent/legal guardian also provided consent to participate i n the study. Because it was reasonable to assume that the participants themselves were capable o f understanding and m a k i n g decis ions about their o w n part icipat ion, they were also required to p rov ide their o w n assent to participate. A s indicated by the Behav iou ra l Research Eth ics board, assent was described as the part icipant 's agreement wi th the decis ion o f their parent/guardian to p rov ide consent for part icipat ion, In this way , l ega l ly the participants were g iven consent for 6 2 part ic ipat ion by their parents, but also chose whether or not to give their o w n personal consent for part icipat ion. It was assumed that gifted adolescents, ages 15-18, w o u l d be competent to understand the nature and consequences o f the research and to make fu l ly in formed decis ions regarding their par t ic ipat ion. The assent fo rm indicated that the minor participant had the right to wi thdraw f rom the study at any t ime without consequence. Participants over the age o f 19 were required to provide informed consent on their o w n behalf. The ind iv idua l s w h o served as p i lo t in terview participants also provided their fu l ly informed consent. T h e m a i n points addressed i n the various consent forms were the contact in format ion for student researcher and research supervisor, the part icipant 's right to vo lun ta r i ly wi thdrawal at any t ime, the central purpose and procedures to be used, assurance o f the confident ia l i ty o f the part icipant 's involvement and the data col lected, and a reference to any k n o w n r isks associated w i t h part icipation. A copy o f the fo rm was s igned pr ior to invo lvement i n data co l lec t ion , and the participant was g iven a c o p y conta in ing contact informat ion to refer to for any further information i f needed. It was made clear f r o m the onset o f the research process that participants were free to wi thdraw their par t ic ipat ion at any t ime pr ior to the f ina l analysis o f data without jus t i f icat ion or penalty. Please see Append ice s for various consent forms and letters o f contact approved by the U B C behaviora l ethics r ev iew board for use i n this study. Interview Procedures and the Phenomenological Interview . Open-ended phenomenologica l interviews were i nd iv idua l l y conducted w i t h each o f the participants. A c t i v e l is tening, empathetic reflection and m i n i m a l encouragers were used throughout the in terview to a l low the phenomenon to be expressed through the part icipants ' 63 perspective. V e r b a l prompts were used throughout the interview process to facilitate the elaboration o f themes brought up by the participant, to clar i fy and elaborate on the meaning and the emotions related to what was verbal ized by the participant. F o l l o w i n g the orientating introduction, participants were encouraged to te l l the story o f their experience o f disordered eating i n their o w n words and wi th as m u c h detail as possible . It was suggested that a good way to do so might be to think back to a t ime when they d i d not experience the eating disorder, and to take me through that t ime to the present. Part icipants were encouraged to articulate their experience i n relat ion to their environment at home, at school , w i t h friends and fami ly and to elaborate on the meaning and emotions related to their experiences. Please see A p p e n d i x B for Interview pro tocol and example in terview questions used as a guide for each participant in terview. The interview length was determined by the participant and var ied i n length f rom 1.5-2.5 hours. The in terview length as determined by participant was a funct ion o f when the adolescent appeared to feel that they had described their experience o f their eating disorder, and a l l themes w h i c h seem to have emerged were addressed at the leve l o f depth that each felt was adequate. F o l l o w i n g each interview, some t ime was spent w i th each participant to ensure that they were not exper iencing psycho log ica l distress or discomfort . N o n e was reported, and we explored feedback about their part icipation in the interview. The transcript ion procedures and data analysis to f o l l o w was br ief ly described, and each participant was agreeable to future contact to check back wi th them at points throughout the data analysis when their feedback w o u l d be o f assistance. E a c h participant expressed an interest i n k n o w i n g more about the f indings as they emerged, and seemed to express an op in ion that the purpose o f this 64 study was important and meaningful to them. Later contact w i th the participants to update them on the progress o f the study and analysis, and to validate the summary o f their experience, cont inued to be met w i t h enthusiasm for the study topic, and for h o w they felt that their story was appreciated and heard throughout the in terview process. Transcription Procedures F o l l o w i n g the participant interviews, the audiotapes were subsequently transcribed verbat im. G i o r g i and G i o r g i (2003) suggest that the data o f phenomenologica l study are the "careful and accurate depict ions o f the o f the everyday w o r l d events o f the participants, [and] .. .that there are no rat ional grounds to reject them" (p. 248). T h e u t i l i ty o f verba t im accounts o f the phenomenon i n the participants ' o w n words is h igh ly regarded i n the case o f descript ive phenomenologica l procedures according to K a r l s s o n (1993), G i o r g i (1985), and G i o r g i and G i o r g i (2003). A s the data analysis procedures chosen are based on the approach taken by K a r l s s o n , G i o r g i , and G i o r g i and G i o r g i , verbat im transcription o f verbal audio-taped interviews became the raw data o f the analysis procedures. In some o f the instances the student researcher comple ted the transcript ion, and i n other instances a transcriptionist was used. The or ig ina l interviews, once transcribed, var ied i n length f rom 18-30 single spaced pages. E v e r y audio-taped interview was l is tened to several t imes by the student researcher to carefully cross check for accuracy and also to begin to engage i n the necessary " i m m e r s i o n " i n the data that is required pr ior to any content analysis o f the data. 65 Maintenance of Confidentiality A n y personal identifying information related to participants has been and w i l l be kept strictly confidential. The data were stored on floppy diskettes and computer hard drive. Audio recordings, transcripts and diskettes of participant interviews were stored in a locked fil ing cabinet. N o transcript or computer file (diskette or hard drive) contained the identification of the participant, and were identified only by a participant number and pseudonym. Signed consent forms were kept separate from the data to ensure that the anonymity of the participants is maintained. Interviews conducted were audio-taped. Only the student researcher and thesis supervisor have access to the interview recordings, transcribed data, and analysis in its entirety. Anyone with access to data was required to verbally agree to maintain confidentiality despite the fact that the recordings contained little, i f any identifying information. Only the student researcher and supervising committee had access to the interview protocols in their entirety and data throughout the analysis procedures. Audio recordings from the interviews conducted were kept in a locked filing cabinet. Participants have not been and wi l l not be identified by name in reports or in any material, discussion or presentation relating to the project. Identifying information which may compromise the anonymity of the participants was not included as specific identifying information in the later stages of data analysis or presentation of findings. A l l participants are free to make their own decisions about disclosing their participation to whomever they choose and have a right to do so; however their identity w i l l remain confidential by the researcher. In the instances where a qualified professional assisted with the initial recruitment by passing along the recruitment information to appropriate potential 66 participants, the relationships are confidential i n nature, and w i l l therefore also respect the anonymi ty o f the ind iv idua ls w h o received recruitment information. A l t h o u g h professionals m a y gain knowledge o f research part icipat ion f rom their clients, they w i l l never receive conf i rmat ion o f par t ic ipat ion f rom the student researcher. Data Analysis M c L e o d (2001) summarizes the a i m o f phenomenology as p roduc ing an "exhaust ive descr ipt ion" , and its "ult imate g o a l " as "[elucidating] the essence o f the phenomenon be ing studied, as it exists i n the participants ' concrete experience" (p. 41) . K a r l s s o n (1993) suggests that the ' ra ison d'etre' o f the E m p i r i c a l Phenomenolog ica l P s y c h o l o g i c a l A p p r o a c h w h i c h is a descript ive phenomenologica l method, is to deepen one's understanding o f the phenomenon be ing studied. Th i s is accompl i shed through reveal ing "eidet ic d imens ions" , or the essence o f the phenomenon (p. 88). The search for the essence and mean ing structure o f the phenomenon o f interest is also a goal o f the descript ive phenomenolog ica l analysis out l ined by G i o r g i (1985), G i o r g i and G i o r g i (2003), and K a r l s s o n (1993). Af te r the in terview was transcribed, subsequent data analysis f o l l o w e d the descr ipt ive phenomenolog ica l data analysis procedures as described by G i o r g i (1985), G i o r g i and G i o r g i (2003) and K a r l s s o n (1993). The E m p i r i c a l Phenomenolog ica l P s y c h o l o g i c a l A p p r o a c h (EPP-method) out l ined by K a r l s s o n , and The Descr ip t ive Phenomeno log ica l P s y c h o l o g i c a l A p p r o a c h out l ined by G i o r g i and G i o r g i , p rov ided the basis for data analysis . T h e researcher's understanding and famil iar i ty w i th various aspects o f descript ive phenomenology were supplemented through thorough explora t ion o f many o f G i o r g i ' s o r ig ina l w r i t i n g (i.e., G i o r g i , 1985, G i o r g i , 1997). 67 Throughout the analysis and data co l lec t ion a phenomenologica l attitude and "part ial phenomenonolog ica l reduct ion" were adhered to. Through this stance, w h i c h invo lves "bracket ing a l l theories, hypotheses, models and systems w h i c h are otherwise used i n order to exp la in the phenomenon i n quest ion" (Kar l sson , 1993, p. 81), the meaning structure o f the experience o f an eating disorder for the participants was explored. A s per the out l ined procedures for phenomenologica l analysis referred to by G i o r g i and G i o r g i (2003) and K a r l s s o n (1993), data analysis procedures were as f o l l o w s . It was noted that the strength o f the analysis as a whole rests on each o f the i n d i v i d u a l steps, and that each o f these steps bui lds on the last. The data analysis procedures f o l l o w ; l i s ted i n number points are those indicated and described by the said theorists. The numer ica l sub-points are id iosyncra t ic ways i n w h i c h the data analysis procedures were implemented and further broken d o w n by the student researcher i n order to manage the data f o l l o w i n g the transcript ion process. Throughout these steps, bracket ing o f the researcher's biases was appl ied, reflected on, and moni tored i n the reflective journa l . 1. R e a d i n g o f the transcript for a grasp or sense o f the who le and immers ion i n the text. a) Transcripts were read through several times for a sense o f the parts and h o w they related to the totality o f the experience articulated through the in terv iew. b) A u d i o taped interviews were listened to several t imes to verify accuracy w i t h the transcripts and to also engage i n immers ion i n the data and the experience o f the eating disorder for the participants. 2. M e a n i n g units ( M U s ) were established and represented a breaking d o w n o f the transcripts into smaller units. M e a n i n g units were defined as subjective shift i n meaning discerned when the researcher denotes a shift i n meaning. G i o r g i and G i o r g i 68 (2003) suggest that meaning units are not required to be ident ical between researchers, and are not "theoretically weigh ty" or "object ive", and are more o f pract ical a id i n managing the analysis (p. 252). a) M e a n i n g units were delineated when a shift i n meaning was intuited and when it seemed as though the content o f each unit had one meaning, even i f it c o u l d be interpreted in more than one way . b) E a c h transcript was broken d o w n into between 320 and 480 mean ing units, each was noted wi th a slash mark (/) in the transcript. c) A t this stage the thesis supervisor assisted in ve r i fy ing samples o f del ineated meaning units among several transcripts, typ ica l ly w i t h very h igh agreement. d) The meaning units delineated in the transcripts were transformed into tables i n w h i c h the 1 s t c o l u m n represented the participant number, the 2 n d c o l u m n represented the M U number, and the 3 r d c o l u m n represented the text o f the M U . e) Later i n the analysis, i f a meaning unit appeared to require further b reak ing d o w n , this was done at that stage. G i o r g i and G i o r g i (2003) describe the 3 r d stage as "transformation o f the mean ing units into psycho log ica l ly sensitive expressions" (p. 252). It is suggested that at this stage the psycho log ica l relevance o f the meaning units as they relate to the phenomenon are developed. It is cautioned to avo id the errors o f us ing p sycho log i ca l ja rgon at this stage and to not take the relevance o f the personal l ives o f the participant beyond the psycho log ica l experience o f the phenomenon. K a r l s s o n (1993) refers to this stage as the "eidetic induct ion through interpretation". It is at 69 this stage where the meanings o f the phenomenon and M U s as articulated by the participants are elaborated on and g iven psycho log ica l meaning . K a r l s s o n (1993) specifies two "modes o f understanding" to engage i n this process, 1) the "researcher 's empathetic understanding" ( R E U ) , and 2) the "researcher's interpretive understanding" ( R I U ) (p. 86-87). The R E U is v i e w e d more as an understanding o f the experience o f the participant at a " c o m m o n sense" and "straight fo rward" l eve l , and the R I U "brings forth the meaning structure" o f the experience and contributes to understanding the under ly ing essence and meaning o f the phenomenon (p. 87). K a r l s s o n suggests that the R E U is subordinate to the R I U , and that it is the interpretative understanding o f the researcher that is more important, yet movement between the two ways o f understanding are cr i t ica l to this stage o f the analysis . K a r l s s o n also cautions that "theory-laden language" be avoided at this stage (p. 98). a) T h e 4 t h c o l u m n of the table used for data analysis represented where this stage o f the analysis took place. b) T h e content o f the meaning units were "coded" based on the pr inc ip les o f g i v i n g psycho log ica l meaning, empathetic and interpretive understanding as out l ined above. c) The pr imary psycho log ica l meaning as it related to the phenomenon was noted first (for example: Perfect ionism, Apprec i a t ion and Recogn i t i on o f V a l u e , Purpose, etc.) and then was further elaborated on w i t h details o f the part icular code. Th i s step a l l owed for ease i n sorting the M U s and codes us ing computer-aided sorting o f tables. 70 d) A t this stage m y thesis supervisor assisted in cod ing when d iscerning the psycho log ica l meaning o f the M U s posed dif f icul ty , and val idated samples o f coded M U s f rom several participant tables. e) The coded M U s were sorted for each participant i n i nd iv idua l tables. f) T h e coded meaning units were combined into one table and also sorted i n that format (table i n excess o f 160 pages). T h e four co lumns used enabled decipher ing o f the codes or themes that were core and c o m m o n among the participants. G i o r g i and G i o r g i (2003) note this step as the last, and do not make exp l i c i t the f ina l stage out l ined by K a r l s s o n (1993). G i o r g i and G i o r g i identify this stage as the "determinat ion o f structure", and where one identifies what is t ruly essential and the most " invariant connected meanings be longing to the experience", resul t ing i n descr ipt ion o f the psycho log ica l structure o f the phenomenon (p. 253). K a r l s s o n (1993) refers to the fourth stage as representing the "situated structure" or synopsis o f the part icipants ' experience o f the phenomenon. a) E a c h participant table, w h i c h had been coded and sorted to reveal the core and essential themes o f each experience o f the phenomenon, fo rmed the basis for the situated structures developed for each participant. b) The core themes f rom each participant were o v e r w h e l m i n g to organize based on the length o f the tables. T o provide ease in o rgan iz ing and deve lop ing a coherent account o f their experience, core themes were represented i n a v i sua l concept or theme map, w h i c h guided the way in w h i c h each part ic ipant 's story w o u l d be developed. c) Care was taken to incorporate a l l aspects o f the phenomenon, as they were presented by the participant, in a short length format. d) A t this stage, the thesis supervisor proofread and p rov ided feedback on each situated structure developed. e) E a c h participant was g iven a copy o f their situated structure and asked to provide feedback. T h e y were requested to respond to whether the summary fit or resonated wi th the experience o f the phenomenon as they descr ibed it i n the in terview, and i f any significant themes were left out. T h e f inal stage is the development o f a general structure based on the core and c o m m o n themes o f a l l participants. Ka r l s son (1993) defines the f ina l step o f the analysis to include ( i f possible) the general structure among many examples o f the phenomenon. K a r l s s o n suggests "It is imposs ib le i n advance to make a general statement about exact ly upon w h i c h leve l o f abstractness the results w i l l be expressed. It is up to each researcher to determine h o w far the analysis w i l l g o " (p. 80). I f possible , analysis should proceed to typo log ica l or general structures w h i l e keeping i n m i n d that the "interesting psycho log ica l d iscover ies" should not be ove r looked and to consider the leve l o f abstraction that is o f value to the researcher (p. 108). a) A general structure, or the core and c o m m o n themes o f the experience o f an eating disorder among the sample was developed based on the f inal themes i n the sorted table, i nc lud ing a l l participants ' account o f the experience. 72 b) The themes for each of the participants were sorted through, and the common themes outlined and described based on several methods of organizing the data (for example: based on participant quotes, common themes, reorganized when a sub-theme was contained in coded meaning unit, etc.). c) Each theme was justified based on reference back to the original transcripts and individual sorted tables. d) The common themes were sorted and organized into main and sub-themes. e) Each theme and sub-theme was described, and then elaborated on and validated through thick description and participant quotes. Presentation of Findings At the onset of the data analysis process, it was unclear how the data may be represented in their final form. Karlsson (1993) suggests that a general structure may be the end result of the data analysis "when all protocols can be meaningfully condensed into one single structure" (p. 88). Karlsson also suggests that a study should consider "typological structures", which is preferable when "more than one structure of the phenomenon" is contained in the data, due to the risk of loss of psychological meaning should the data be forced into a general structure (Karlsson, 1993, p. 88). Karlsson suggests that results according to the EPP-method may contain "both general and typological constituents" (p. 88). A situated structure was developed for each participant, and the possibility of either a general or typological structure was seen as a realistic possibility for the final data analysis and presentation of findings. Upon completion of the data analysis, which involved Over 160 73 pages o f coded data i n table format, core and c o m m o n themes for a l l participants were developed. T h e general structure, or core and c o m m o n themes represents "general constituents" as descr ibed by K a r l s s o n (1993) o f the experience o f an eating disorder, w h i l e the situated structures presented i n the f indings are less abstract and speak more to the subjective experience o f each unique participants ' l i v e d experience o f their eating disorder. Ethical Considerations T h e protocol and nature o f this study received fu l l ethical approval f rom the B e h a v i o u r a l E th ics R e v i e w B o a r d o f the Un ive r s i t y o f B r i t i s h C o l u m b i a . Strict e thical standards were mainta ined throughout the recruitment, interview, transcript ion and data analysis processes. Subsequently the study was granted renewal and amendment to a l l o w for future use o f the data and contact w i th participants. The l imi t s o f confident ial i ty were agreed to and were understood by the part icipant at the onset o f the in terview process. Th i s was essential to ensure the p sycho log i ca l and phys ica l safety that m a y relate to recounting a phenomenon such as this. A n y disc losure o f a part icipant 's intent to ha rm themselves or another person, or reported incidents o f c h i l d abuse w o u l d have been reported to the proper authorities. A l l participants were rece iv ing or have received eating disorder counse l l ing or treatment for disordered eating. A l l participants indicated that they had easy access to support f rom their present or past eating disorder treatment providers . T h i s p rov ided some assurance that the part icipants ' p sycho log i ca l w e l l -be ing is addressed more thoroughly and on an on-going basis i f necessary by other qua l i f ied professionals. F o l l o w i n g the interview process, I spent t ime wi th each part icipant to debrief any feel ing o f psycho log ica l stress or upset that they may be feel ing. N o part icipant 74 indicated verba l ly or through m y observation to be psycho log ica l ly unsafe or vulnerable f o l l o w i n g the in terview process. M o s t participants expressed an enthusiasm for hav ing engaged i n the interview process and several mentioned that they l ooked forward to t a lk ing about the value and experience o f the in terview wi th their personal therapist. A l t h o u g h I w o r k i n the eating disorders f ie ld as a therapist and d i d have direct access to several potential participants through that role, i n no instance d i d I engage i n a dual relat ionship w i t h a participant, i n w h i c h I functioned as the part icipant 's therapist. I chose to avo id recrui t ing any clients who receive services through the p rogram where I a m e m p l o y e d to a v o i d poss ible ethical considerations, discomfort , or dual relationships i n the future. Delimitations T h i s study intended to provide an in-depth descript ion o f the experience o f an eating disorder among gifted female adolescents. P r io r to beginning the study several del imita t ions were noted based on the selection o f a qualitative research paradigm, the accompany ing methodology, part icipants ' factors, and the operational definit ions that were u t i l i zed . T h e results o f this study cannot be considered comparable to the experience o f disordered eating among other specific sample populat ions. A quali tat ive descr ipt ion o f the experience o f an eating disorder among a non-gifted populat ion is not, to m y knowledge , currently avai lable so it is not clear h o w the results o f this study relate to other populat ions . T h e narrative descr ipt ion o f the core and c o m m o n themes o f the l i v e d experience o f disordered eating, therefore, may or may not reflect the experience o f "non-gif ted" adolescents. T h e issue o f whether gifted adolescents actually experience an eating disorder in a unique way , or whether it is on ly the way i n w h i c h they articulate their experience that is 75 unique is a significant considerat ion. G i v e n the nature o f the chosen method the sample size was sma l l (6-10 participants) w h i c h has impl ica t ions for the general izabi l i ty o f the f indings. T h e def ini t ion o f giftedness i n current literature is inconsistent ly and poor ly defined, and the operational def ini t ion o f giftedness i n this study may not agree wi th that used i n other publ icat ions . Whether or not the gifted populat ion i n this study matches the gifted popula t ion o f other studies is relevant but this del imi ta t ion is inevitable g iven the lack o f a universa l operational def ini t ion for giftedness. T h e identif icat ion o f gifted adolescents through par t ic ipat ion in gifted and talented educational programs or b y cons ider ing advanced cogni t ive development may have exc luded several potential participants f rom the sample. D u a l relationships wi th participants were avoided (i.e., counsel lor and researcher). G i v e n the secretive nature o f disordered eating, the participants ' age, and the part icular reluctance o f gifted adolescents to share their experiences wi th those they do not k n o w , noted by Jackson and Person (2003), it is questionable whether sufficient rapport c o u l d be established for participants to share their experiences openly. Diversity Issues T h e focus o f this study was on female participants who have in the past f ive years experienced, or w h o currently experience disordered eating as adolescents (age 15-18). Invest igat ion o f a female adolescent populat ion was chosen based on the higher prevalence o f disordered eating among females than males ( A P A , 2000). T h e experience o f disordered eating among male or adult populations may differ, and for that reason the target sample is l im i t ed i n that respect. Adolescents younger than 15 years o f age have also been exc luded , as their experience m a y also differ or be articulated differently than that o f older adolescents. 76 Participants were required to speak E n g l i s h , as it is the pr imary language o f the student researcher. Interviews, transcription, data analysis and the writ ten thesis project w i l l be communica ted i n E n g l i s h . Non-g i f ted adolescents as defined by the select ion cr i ter ia and operational definit ions chosen pr ior to conduct ing the study were not inc luded i n the sample. T h i s exc lus ion was not based on any discr iminatory bias, but instead to narrow the focus o f the sample, subsequent analysis and results to a target popula t ion. Validity and Reliability M a x w e l l (1992) comments on the frequent challenges to the va l id i ty o f qual i tat ive research and f indings. Despi te the challenges o f establishing va l id i ty and cons ider ing various approaches and methods to do so, it is agreed that qualitative studies must demonstrate c red ib i l i ty (Creswe l l & M i l l e r , 2000) . M a x w e l l (1992) refers to several forms o f c red ib i l i ty /va l id i ty that should be considered i n qualitative research. The two forms o f va l id i ty that are o f part icular relevance to this study inc lude descript ive and interpretative va l id i ty . Descr ip t ive va l id i ty refers to the "factual accuracy o f their [the researcher's] account - that is that they are not m a k i n g up or distort ing the things they saw or heard" (p. 285). Interpretive va l id i ty refers to the descriptions and meaning interpreted f rom the participants ' perspective. In this study, the standards o f descript ive va l id i ty described were met through audio taping o f the interviews and careful ver i f icat ion o f transcripts. Standards o f interpretive va l id i ty were met through ver i f ica t ion o f analysis at each stage w i t h m y thesis supervisor, and through feedback f rom participants, w h i c h conf i rmed that the descript ion and meaning o f their experience interpreted by the researcher resonated wi th them. 77 In an attempt to c lar i fy and organize some o f the methods for establ ishing va l id i ty i n quali tat ive research, and to a id i n their choice and use, C r e s w e l l and M i l l e r (2000) p rov ide a f ramework through w h i c h va l id i ty may be considered. It is suggested that depending o n the lens through w h i c h the researcher v iews the study, certain va l id i ty procedures shou ld be considered. It is suggested that one lens through w h i c h va l id i ty should be considered is that o f the researcher, another is that o f the participants i n the study, and the last is a c r i t i ca l lens. Depend ing on the lens used, specific va l id i ty procedures may inc lude: 1) t r iangulat ion o f data, 2) use o f d i sconf i rming evidence, 3) researcher ref lexiv i ty and disclosure o f biases, assumptions and beliefs, 4) member checking- taking data and narratives developed back to the participants, 5) pro longed engagement in the f i e ld , 6) col laborat ion throughout the research process w i t h participants, 7) an audit trai l to examine both the process through w h i c h the results emerged and the f inal results, 8) thick, r i ch descript ion o f the participants, setting and results so that the reader may generalize f indings, and 9) peer r ev iew or debrief ing -where someone famil iar w i th the phenomenon reviews that data, analysis , and results. M c G r a t h and Johnson (2003) discuss issues related to establ ishing c red ib i l i ty (va l id i ty or truth) and trustworthiness i n qualitative research. L i n c o l n and G u b a (1985) suggest that trustworthiness is the central and most c r i t ica l standard to w h i c h any study should be he ld (as c i ted i n M c G r a t h & Johnson). C r e s w e l l (1998) also refers to the w o r k o f L i n c o l n and G u b a and articulates how terms used i n assessing the qual i ty and ver i f ica t ion o f quali tat ive w o r k include the study's c redib i l i ty , transferability, dependabi l i ty and conf i rmabi l i ty . Internal va l id i ty refers to the c red ib i l i ty or truth o f the f indings i n quali tat ive work , external va l id i ty refers to transferability or whether f indings transfer f rom researcher to 7 8 those be ing studied, re l iab i l i ty and object ivi ty refer to whether the quali tat ive results are dependable and conf i rmable through audit ing and bracket ing o f the researcher's biases. Procedures for establishing trustworthiness, c red ib i l i ty and ver i f ica t ion used i n this study include: 1) stating and reflecting on biases, assumptions and beliefs related to the phenomenon o f interest throughout the research process, use o f f i e ld notes, and a reflective journa l , 2) member check ing , as the lens o f the participants was seen as the most r igorous fo rm o f va l id i ty ver i f ica t ion, 3) an audit t ra i l , in w h i c h a l l research and data analysis procedures were out l ined i n detailed and moni tored by the thesis supervisor, 4) th ick and r i ch descr ipt ion o f the f indings, substantiated by direct quotes, so the reader m a y come to their o w n conclus ions about the transferability o f the f indings. 79 C H A P T E R I V Results T e n m a i n codes emerged through the analysis o f data. These themes represent the general structure, core and c o m m o n themes o f the experience o f an eating disorder among the gifted female adolescent participants. These themes include: 1) Nega t ive Af fec t and Self-Perceptions, E m o t i o n a l P a i n , and Deter iorat ion, 2) O v e r w h e l m e d and Conf l i c t ed , 3) N o t F i t t ing : Incongruence and Awareness o f Differences, 4) C o p i n g T h r o u g h E n g a g i n g i n the Ea t i ng Disorder , 5) Exper ience o f Giftedness and Ea t ing Diso rde r and/or Struggle E x p l i c i t l y Connected , 6) Per fec t ion ism-St r iv ing to A t t a i n "Perfect", 7) C o n t r o l and Res t r ic t ion , 8) Awareness o f Mul t i f ace ted U n d e r l y i n g Factors, 9) Sacr i f ice , Def iance and Separation: O f Self , o f B o d y , and o f Needs , 10) Apprec ia ted , Purposeful and M e a n i n g f u l Exper ience . Severa l o f these themes also contain sub-themes, w h i c h further elaborate on and prov ide depth to the themes that they are subsumed by. A l l o f the m a i n themes represent the invariant structure or essence o f the experience o f an eating disorder for each o f the participants. E a c h sub-theme applies to the experience o f A n o r e x i a for a l l or the majori ty o f the participants. The sub-themes are under l ined throughout the presentation o f the results. Presentation o f the f indings i n this chapter includes a situated structure for each participant, w h i c h details the essence o f their personal eating disorder experience, f o l l o w e d by a table that outl ines the ma in themes and sub-themes o f the general structures among the participants. T h e themes and sub-themes are further elaborated on through r i ch descr ipt ion and excerpts f rom the participant interviews, w h i c h validate the themes and provide examples o f their substance through the "lens o f the participant". 80 Situated Structures Esprit There is a connection between my sensitivity and kind of being more of like a sponge, in between that and being more prone I guess to having problems. Esprit's struggle with Anorexia is one in which she searches for the meaning and purpose of its presence in her life. She experiences feelings of self-blame and guilt for allowing Anorexia into her life when she should "know better". A sense of frustration with the non-rational and complex nature of eating disorders and a continuous struggle is present in her experience. Conflict and incongruence within herself arise and comprise the "root of her struggle", as she considers the meaning of thinness and the contradiction between her focus on physical attributes while valuing more fully "beauty of character". What began as a means to fit in, to seek control when other areas of her life felt out of control, and a way to "be healthy", led to restriction of her intake, rapid weight loss and physical deterioration which resulted in her being medically compromised and hospitalized. She describes her eating disorder as having a voice as she attempts to externalize Anorexia from her sense of self. The voice of the eating disorder is critical of her, and has destructive and negative intentions for Esprit. Esprit experiences fear and emotional pain as she considers whether she w i l l be able to let go of her eating disorder. She explicitly connects giftedness with perfectionism, psychological and existential struggle, and her personal experience with Anorexia and Depression. She challenges whether the qualities that she appreciates as being part of giftedness w i l l "always go hand in hand" with Anorexia, and whether she can maintain those 81 qualit ies yet recover. She questions whether an inevitable struggle w i l l exist for those w h o , l i k e her, experience the w o r l d i n a different way . Is it the perfectionism and perseverance, sensitivity and awareness of the world that enables you do well at school and open to the rest of the world and see there are so many things that need changing and yes it is overwhelming but finding something that I can do, starting projects or being active and it's great. That's my life that's what I want to do always but at the same time it is the same kind of things that keep Anorexia going in me and adds fuel to the fire... perfectionism and destructive behaviour. Frustrat ion and conf l ic t arise w i th in her as she experiences guil t related to exper ienc ing her o w n struggle wh i l e she is mindfu l o f the suffering o f others. She indicates that through her eating disorder she is cop ing wi th the " P a i n o f Ex is tence" , w h i c h she describes as: The pain of finding your place in the world and the universe. Trying to go beyond yourself, trying to make sense of things, not understanding things, why things happen, unfairness. The conflict between our best intentions and what actually goes on in everyday life H e r reaction to the w o r l d and to the " P a i n o f Ex i s t ence" is o v e r w h e l m i n g to her, and leads her to feel ing trapped by qualit ies w i th in herself w h i c h she seems to cher ish , but also sees as the basis for her self-destruction. A n o r e x i a a l lows her to cope by in te rna l iz ing the pa in that she feels f rom the environment and i n reaction to the w o r l d . She experiences conf l i c t ing dynamics w i t h i n herself when she acknowledges that the power and mean ing o f phys i ca l ideals and thinness, ideals she considers " sha l low" , are part o f her struggle and are 82 incongruent w i t h the depth o f her experiences, feelings and values. She continues to h o l d on to the not ion that thinness may br ing her happiness and a l low her to "f i t i n " , a l though she is cogn i t ive ly aware that is not the case. A n o r e x i a has been a way for Espr i t to cope wi th many o f the challenges and incongruous elements i n her environment. She is aware o f her differences f rom her peers and o f the i so la t ion and separateness she feels even w i t h i n her o w n fami ly . Pe rce iv ing herself as " chubby" as a c h i l d , fee l ing different f rom her peers, and not f i t t ing i n developmenta l ly , are a l l connected to her search for happiness through a phys ica l ideal . F i t t i ng i n p h y s i c a l l y appears to have been an attempt to deal w i th "pa in and sadness", and to fit i n , i n a more general sense. The apparent solut ion that A n o r e x i a promised does not appear to have been achieved as she works toward accepting her awareness o f her differences. Espr i t describes heightened sensitivities to the "subtleties" i n her environment and to the expectations, needs and feelings o f others. She relates her "sens i t iv i ty" to w h y the eating disorder took h o l d o f her l i fe and control led her. Throughout her experience she identifies be ing cont ro l led by her eating disorder and by those around her. The i rony o f the means through w h i c h she sought control then taking control o f her and her l i fe is present i n her consciousness. Esp r i t sees a need for personal control , and defiance o f her parents' expectations and their perce ived control o f her, as a basis for her need to use restriction o f her intake as a means to cope and as a solut ion. She indicates that she gains a sense o f power and satisfaction f rom defying her phys io log ica l needs. A s a "good g i r l " , she appears to feel that she found a w a y to internalize her pa in rather than externalize it or to defy her parents i n " t y p i c a l " adolescent fashion. 0 83 Espr i t strives to l i ve up to h igh self-expectations characterized by perfec t ionism w h i l e she attempts to satisfy her o w n "image o f h e r s e l f . H e r perfect ionism extends into her humanitar ian endeavors and desire to care for others, w h i c h she sees as "perfect ion towards others". H e r experience wi th in her o w n fami ly through her experience o f A n o r e x i a is one i n w h i c h she has felt that she has been ident i f ied as the p rob lem. She tries to see A n o r e x i a or malfunct ion as something that exists in her whole f ami ly and that she is mere ly the member that "embodies i t" . She has internal ized c r i t i c i sm, feelings o f gui l t and b lame that she perceives as ex is t ing in her f ami ly ' s reaction toward her. Espr i t continues to maintain hope that she w i l l be free o f A n o r e x i a , and i f she is unable to recover for herself then she m a y be motivated to recover for others. A s she searches for h o w to make sense o f and f ind meaning i n her experience, she reflects on her appreciat ion o f the value o f the eating disorder i n her l i fe . She feels that through her struggle she has become more compassionate, gained strength, and g rown. A n o r e x i a is not an experience that she is sure she w o u l d trade i f g iven the opportunity. "it definitely makes you a stronger person in the end if you get to the end." Andrea I was starving myself to the point of death, but not for the purpose to be skinny, but for the purpose of being erased A n d r e a ' s struggle wi th A n o r e x i a is one o f searching, purpose, and separation o f m i n d and body . It is also a means through w h i c h to cope wi th elements i n her experience that 84 ove rwhe lmed her and that she became trapped by . A n o r e x i a was a w a y for her to separate and dissociate herself f rom her body, f rom her phys ica l and emot ional needs, her react ion to the w o r l d , her sacrif ice o f her o w n needs for those o f others, as w e l l as peer and f a m i l y environments w h i c h d i d not fit for her. A n d r e a is unable to remember a t ime when eating was "not a b i g dea l " for her. She recalls body preoccupat ion amongst her earliest memories . She sees her body as more o f a vehic le through w h i c h to accompl i sh things than as part o f herself. "I've a lways l i ke g iven l i k e a pedestal to . . . the idea o f sacr i f ice" . Sacr i f ice o f her body for achievement o f goals and sacrifice as a requisite for success relates to her experience wi th starvation and A n o r e x i a . A n o r e x i a was not about phys ica l ideals or thinness but was about be ing "successful at something", "at a l l costs". Sacr i f ice gives mean ing to her experience o f A n o r e x i a . W h a t began as an attempt to be "healthy" and active led to severe restr ict ion o f her intake, s ignif icant weight loss and hospi tal izat ion. Andrea ' s experience includes awareness that "despite it a l l be ing about eating and not eating, it has nothing to do w i t h i t" . W h i l e she was med ica l l y compromised she experienced be ing control led by others and rece iv ing interventions that were incongruent w i th her needs. Despi te regaining phys i ca l health, she indicates that her eating disorder and the under ly ing issues continue to " thr ive" . She has at t imes feared the control that the eating disorder has had over her. A n d r e a is saddened but resolved towards the on-going and cont inued invo lvement o f A n o r e x i a i n her l i fe . She has dif f icul ty consider ing her self-identity or l i fe in its absence, and A n o r e x i a ' s longstanding presence i n her l i fe is seen as a "part o f her. She has come to define herself through her abi l i ty to control her body and to shape it at her w i l l . She faces 85 conflict within herself related to whether she may ever be ready to let go of Anorexia, as it allows her to cope. Through her experience she gains a sense of control, power and satisfaction by defying physiological needs and also defying her heightened awareness of the needs and emotions of others, which she perceives, mirrors and internalizes. A s she felt trapped by her awareness and her feeling of "carrying the weight of the world", she identifies that her eating disorder led to a self-destruction, separating herself from her body and allowed her to no longer have to cope with the elements of her experience that trapped and overwhelmed her. Her experience involves not only restriction of her intake but of her emotions, her attachment to others, and the depth of her experiencing through withdrawal and separation. Denial and defiance of the connection between her mind and body, a connection to her human needs and her reaction towards the world, is related to her experience of Anorexia. A feeling of burden in reaction to the world is overwhelming to her and led to her self-destruction through Anorexia as a means to cope as she describes: I love life and I love living it, and you know, it's a wonderful thing, but to also have a large hatred for the world and how it works, and how it you know um whether people think it's fair or unjust and ...its just that I find that as an individual I just feel like just a heavy weight of all problems in the world that I just like, I don 'tfeel like I have to solve them, but I just feel them and I experience them and I just there's ways that eventually you can't take it anymore and you do eventually sort of self destruct 86 Andrea conceptualizes her eating disorder in a metaphorical sense. She sees her experience as a search for something; a hunger represented by starvation and coldness of her body and emotional and spiritual coldness. With Anorexia, as in her desire to accomplish and achieve, she wants to "completely exert" herself, yet is "not wanting to partake so much", wanting to give but not to receive. She indicates that often her times of greatest success are those when Anorexia is dominant in her life. She relates her determination, drive, and perfectionism as fueled by Anorexia as well as the basis for its strength. She describes that through her perfectionism she was led to inevitable self-destruction through her eating disorder. She describes a goal of her eating disorder as not to be "skinny" but to "erase" herself. In her mind it seems that her eating disorder is related to her expectations of herself and her determination to excel and accomplish beyond the ordinary. Anorexia was a source of achievement and success as she sought to achieve her mission "at all cost" and to defy death. Opposing dynamics exist in her eating disorder, which she sees as both a means to gain nurturance, care and attention, but also to separate herself from others and to no longer participate in her life. Andrea feels that her family environment was incongruent with her needs, that she was parentified, and did not internalize the care that she did receive. She identifies an awareness of her differences amongst her peers, her heightened emotional awareness, and attention from others on a superficial level as part of what she was escaping from through her eating disorder. 87 Being so sociable, and just being around people all the time, and to be an object of desire to the opposite sex, ...I didn 't want a part of that anymore. I didn 'tfeel, I just kind of wanted to get away from everything and, just kind of separate myself from the physical world I guess... I remember thinking that I wanted to be alone, that I wanted nothing of this, I don't want any emotion, I don't want to have to deal with things. She acknowledges a sense of mission and purpose while engaging in her eating disorder. She indicated that she has found purpose, meaning and appreciation of the value in her experience of Anorexia, although she is conscious of not wishing anyone else to endure such an experience. Andrea sees her eating disorder as a way to have "recreated" herself, to reevaluate and learn about herself and to become more "grounded". She sees her experience of Anorexia as self-destruction as a means to excel or for a greater purpose. She relates necessary self-destruction and resulting higher functioning or "something bigger" to other issues of psychological distress throughout her life. Her "hunger", "constant thirst" or search for something throughout her experience of Anorexia has not been satisfied although her journey is clear. My disordered eating was almost a search for something . ..separation for mind and body. ..ifl was just a mind, then... I would find that something. Andrea continues to search. 88 Phoenix It was like a different species of eating disorder almost...Like throughout the whole thing numerous doctors had said, she's not the textbook case and they didn 't know what to do either. P h o e n i x ' s experience wi th A n o r e x i a is one o f repetitive cycles o f severe restr ict ion o f intake, escalat ion o f her eating disorder struggle, phys ica l deterioration and several hospi tal izat ions and admissions to inpatient Ea t ing Disorder Treatment Centres. A t the height o f her struggle she was consumed by eating disorder behaviours and thoughts, and saw her eating disorder as con t ro l l ing her. She refers to an eating disorder vo ice , "the executioner" , as pervasive and strong, and felt that her every action, thought and feel ing was "choreographed" by the vo ice and her eating disorder. She has di f f icul ty ar t iculat ing her experience verbal ly , as she visual izes much o f her experience o f A n o r e x i a . She sees her experience o f A n o r e x i a as a search for meaning, purpose and cont ro l . Phoen ix sees the turning point i n her struggle wi th A n o r e x i a as occur r ing w h e n the purpose o f it i n her l i fe became clear to her. She sees her experience as not related to causal factors but to a necessary purpose i n her l i fe . She anticipated that she w o u l d experience such a cr is is , b r ing ing authenticity and depth to her experiencing, verbal and emot iona l expression. Res t r ic t ion o f emot ion, expression and exper iencing pr ior to her eat ing disorder had been incongruent w i t h the depth at w h i c h she now feels she was meant to l i v e . A n o r e x i a ' s purpose was to facilitate and enable that l eve l o f depth and expression i n her l i fe . A l ack o f true connect ion wi th others, a long wi th feel ing different and isolated had occurred. 89 She relates her eating disorder and progression to recovery to now being able to experience connections with others and to feeling and expressing her emotions more fully. Phoenix explicitly links giftedness to her experience of Anorexia and to perfectionist and obsessive qualities, which fueled her struggle. She has an awareness of her differences amongst her peers, particularly when encountering other individuals struggling with eating disorder issues. It seems that the uniqueness in her struggle was recognized by treatment providers and contributed to a sense of frustration in response to her eating disorder presentation. She feels that giftedness "puts a whole different spin on things", and that her eating disorder "just felt like a totally different subject matter" and a "different species" of eating disorder. The relationship between her eating disorder and giftedness appears to have been related to several ineffective interventions that she received which were incongruent with her needs. Although initially passive in response to treatment, she responded with defiance once she recognized that she could fight back in response to her perceptions of being controlled by treatment providers. She was also defying the "invisible pressure" and expectations of her parents through her eating disorder. Her expectation of herself to be "perfect", and the "unspoken" expectations she felt from her family to conform, and seek perfection, are also related to her experience of Anorexia. She appears to have felt that as an "anorexic" she should also be "perfect" at having an eating disorder. Phoenix indicates that family dynamics, a lack of depth in the experiencing in her family system, an intertwined connection with her mother, and restriction of family communication are all involved in her experience of an eating disorder. These issues benefited from being confronted and challenged. 90 Phoen ix is aware o f the complex i ty o f under ly ing factors i n her experience that d i d not relate to thinness or food. It was totally not about losing weight or not eating or whatever, it was just a way to control what was going on. It wasn 't like I was trying to lose weight. ...I never had this perfect number in mind, and most other people did. She identifies her eating disorder as "contradictory", as she felt oppos ing dynamics and conf l ic t w i t h i n herself when she was torn between want ing to recover and be ing unable to. She sees herself as "f ight ing getting better and f ight ing not getting better". She felt trapped b y her eating disorder. Phoen ix sees her eating disorder as a metaphor i n her l i fe . She sees A n o r e x i a as a journey toward a l ight that w o u l d provide clar i ty . She conceptualizes her restr ict ion o f intake, as w e l l as restrict ion o f her exper iencing and emotions, as both a force to not eat as w e l l as a force to "stay silent". She has developed a strong sense o f her experience h a v i n g purpose and hav ing been destined. She has come to appreciate the value o f her eating disorder experience, and the awareness and level o f depth o f exper iencing to w h i c h it has prope l led her and her fami ly . a person's mind like, it can either be, it can be stuffed with things that don't really mean anything just a bunch of surface things but then with the eating disorder it kind of cleared it all. It was like whoa, I can see now. Just see everything in a total different light. 91 She conceptualizes her eating disorder as a "teacher" that has allowed her to become herself, to experience and express her emotions, to individuate in her family relationships, and to gain strength and authenticity within herself and in relationships with others. She feels that the eating disorder pushed her to confront the issues in her life that would allow her to feel congruent in the depth of her experiencing and feelings and to "find her voice". A s she expresses: "/ have a voice now, hear me roar! " Emily It's not really about my body at all, even when I was most sick, and depriving myself of food, it wasn 't because I wanted to be thinner, it was because I wanted to take up less space, I wanted to be less, less in the way, less, less of a bother. And the only way to do that would be to take up less space in the world. E m i l y ' s struggle with Anorexia is one of searching for control of her emotions, and coping with heightened sensitivity to the environment, and to the needs and expectations of others. When overwhelmed with the intensity of her emotions and thoughts, and the pressures and stress of her environment, she focused on what she could control- her body. She sought to have "perfect" control while defying death and her physiological needs. She sees her struggle as one of searching for validation, and a means to deal with her perceived "imperfections". For Emi ly , Anorexia is related to feeling worthless, overwhelming emotional pain, and lack of control. "Emotional traumas" became physical when she was unable to cope in any other way. B y taking away physical sustenance, she was provided with 92 a "crutch" which allowed the withdrawal of energy required to deal with "life around her" and her inner pain. It was like being in the middle of a hurricane all the time, and so to try and deal with that, I would run and it hurt physically to run, and so I was able to take my concentration from concentrating on the stuff I didn't know how to deal with, into physically beating my body, cause I could deal with that. I could handle the pain of running, but I didn 't know how to handle the pain of all the emotions. E m i l y began by gradually restricting her intake at a young age. This led to an "obsession" with exercise, severe food restriction, malnourishment, and physical, mental, and emotional deterioration, which resulted in her becoming medically compromised. Although not hospitalized, E m i l y cites one of her goals throughout her eating disorder as hospitalization. This is a goal she still sees as unachieved and as a failure. She felt that i f hospitalized she may prove that she was in control, and may force the attention of those around her to how desperate she had become through the experiences in her environment-a sacrifice of herself to motivate change in her family. Prioritization of the needs of others and sacrifice of her own needs is related to her experience. She maintains that i f she cannot recover for herself, then she may recover for those around her. Her sensitivity and hypervigilance to the environment, her "radio antennae", overwhelmed her and led her to a necessary means to cope and to escape her awareness through Anorexia. / would refuse to acknowledge my needs in order to take care of somebody else. 93 E m i l y sees her struggle as a metaphor, representing a restriction o f her intake, her emot ional reactions, her body, the space she took up i n the w o r l d , and her exper iencing through wi thdrawal and isola t ion. She indicates that she has received interventions that were incongruent w i t h her needs and became " indignant" in response to those w h o saw eating disorders as mere ly a search for a phys ica l ideal or a reaction to med ia influences. A m o n g s t other ind iv idua l s w i t h eating disorder struggles she also felt that her experiences were somehow "different" and that her eating disorder struggle was "deeper". She sees her eat ing disorder as a rebel l ion and defiance different f rom " t y p i c a l " gir ls . She is aware o f her differences amongst her peers and what she sees as her "odd i ty" and "maturi ty" . Those differences have l ed to feelings o f isolat ion and rejection, feelings she responded to w i t h increased intensity o f her eating disorder behaviour and a w i s h to die. She tested the l imi t s o f her phys ica l self and der ived satisfaction f rom control o f her body and phys io log i ca l responses. She felt power as she defied death and the fear and warnings for her l i fe communica ted to her by others. She experienced conf l ic t w i t h i n herself when at t imes she wanted to regain control o f her behaviour, yet the eating disorder cont ro l led her. O p p o s i n g dynamics relate to want ing to be less o f a "bother", and "less not iceable" through her weight loss, although she is aware that it was her weight loss that a l l owed her to gain the attention and fulf i l lment o f unmet needs and insecuri t ies. She sought control i n her l i fe i n response to the "authori tarian" control she felt that her father p laced on her and her f ami ly . Throughout her experience o f A n o r e x i a , when others attempted to cont ro l her, she responded i n quiet defiance by increasing the intensity o f her eating disorder behaviors , or b y a greater determination to continue. 9 4 I was taking control myself I felt, and in a way that um nobody could take away from me, this was my area, I had control, and I was proving to the world that I had control over myself. E m i l y experienced her eating disorder as having a voice. She describes the voice as "ful l of hateful torment", using profanity, and incessantly "accusing" and reminding her of how worthless, ugly, and undeserving she was. She internalized the messages from the voice and the belief that she did not deserve to eat and instead deserved to die. "I didn 't deserve to eat, I deserved to end up in hospital, I deserved to die. " A t times in her struggle she felt "at one" with the eating disorder voice, and it was difficult for her to free herself from its grip. She describes experiencing an eating disorder "trance" in which she dissociated from her body and was not present in her conscious experiences. These appear to be times of her greatest pain and fear within herself. E m i l y ' s sensitivity to the environment and others was heightened in her family system. A n intertwined emotional connection with her mother, and feeling controlled by and fear of her father during a time of pain, discord and change were issues that she was coping with through her eating disorder. She indicates that her relationship with her father and his perceived abuse, contradictory messages, and expectations of her were overwhelming and related to her eating disorder struggle. \ 9 5 Perfectionism was a major part of her struggle with Anorexia as she sought to meet high expectations of herself and the perceived expectations of others. Her search for validation and approval led to pervasive and debilitating perfectionism. She indicates that perfectionism played "such a huge part in [her] life everywhere" and in her eating disorder experience. She experienced devastating personal consequences and lowering of self-esteem when she felt that she could not be perfect or reach the unattainable goals that she set for herself. In her quest to be perfect she clung to the idea that Anorexia may be the one thing that she could be perfect at. I was going to be the ultimate anorexic, I was going to be the anorexic of all or the anorexic of all anorexics... the last option to achieving something for my life was to just... listen to the eating disorder and let that take over. E m i l y has difficulty accepting her continuing struggle with eating disorder relapse and experience of profound depression as she attempts to challenge emotional issues and to heal the "pain of the past". She is reflective of her experience and has a sense of appreciation and gratitude. Through her struggle she feels that she has learned much about herself, her identity and relationships while reevaluating what is important in life. She has begun to internalize feelings of strength, worth and love through her experience of Anorexia, although she would not wish what she has been through on anyone else. It's almost worth it to have learned what I've learned.. .but I wouldn't wish what I've been through on anybody. 9 6 Grace The idea that I should have a perfect life. ..when I felt that I couldn't I had to make at least part of my life perfect and I could be really, really healthy... Grace's struggle with Anorexia is one of a search for control while other areas of her life were perceived as out of her control. She has found meaning in the experience of her eating disorder and come to appreciate the value of it in her life. Grace sought control of her body and health when she felt trapped by pressures of her environment, which were incongruent with her needs. She experienced feelings of desperation, worthlessness, pain and fear as she struggled with the pressure to live up to her "potential". She began to cope through her eating disorder. She is unsure of how the eating disorder "caught on", yet once it did, it dominated her life and consumed her. She felt unable to let go on her own, and at one time felt that her only way out of Anorexia would be to die. While she came to Anorexia to escape from feelings of being trapped, she then became trapped by Anorexia itself. I hated it so much and I really, really wanted out, but I didn't see any road out because getting over it was just way too hard and I felt like the only way out was to die. Grace explicitly links giftedness to her experience of Anorexia, and to the perfectionism that fueled its existence. Feelings of worthlessness arose as she felt that she did not deserve either "her gift" or to eat. She believes that giftedness played a "major part in [her] getting sick" and her eating disorder represented something that she could excel in 97 when she perceived herself as a failure. The pressure that she felt to excel, perform, and to live up to her gifted "potential" led her to feel trapped and to seek control of something; to be perfect at something. She derived a sense of meaning and feelings of happiness, satisfaction, and superiority from her ability to defy her physiological needs and to starve. I think with the giftedness, there's at least some perfectionism that kicks in, and since I couldn't be anywhere close to perfect in any other areas of my life, eating was one area I could be "perfect", and I felt like that too. I felt better than other people, because I could control myself, my hunger, my body. It made me feel superior to others. Her eating disorder allowed her to cope, yet in turn led to desperation, a progression and escalation of her struggle, severe restriction of her intake, physical deterioration and hospitalization, both for suicidal behaviour and treatment of her eating disorder. She expresses an awareness of opposing dynamics and conflict within herself that is characterized by satisfaction and coping through Anorexia, but contrasted with the pain and desperation of her struggle. She is aware that her eating disorder controlled her, and felt that only in giving control to others would she regain hope for her future, for a life free of Anorexia and free of the wish to die to escape her pain and hopelessness. She sees giftedness as both related to personal characteristics underlying her eating disorder dynamics, but also to the reasons why she found herself in a gifted program in which she felt trapped, pressured, invalidated, and where her emotional needs were neglected. She anticipated a crisis and was aware of her deterioration, both physical and 98 psychological. Through her eating disorder she was coping with her environment, emotional pain, void in her life, and pressure to "be an adult" and to perform to her "potential". Grace experienced a preoccupation with being "healthy", and became distressed by her thinness. She did not believe that a certain weight would bring happiness. It was the process of starvation through which she gained control and a focus on something other than her distress and desperation. A fear of fat in her body or intake led to preoccupation with eating "perfectly", and the feeding of and caring for others. Grace identifies her family dynamics as playing an important role in her eating disorder. She prioritized the needs of others, and felt responsible for her family and the "holes" that she saw in it. She played the role of "parent", as she felt she needed to hold the family together. She became consumed with caring for them, and by her eating disorder behaviour and continuous "thinking". Her need to be the "sick one" and her family experience relates to her experience of Anorexia, as she was aware that she could not fight against it in an environment that was incongruent with her needs. She knew she needed to learn to take care of herself and separated herself from them to do so. She feared that change in her eating disorder could not be maintained if the environment in which it developed did not change. Throughout her struggle Grace experienced intense feelings of guilt related to the burden she perceived that she brought to the lives of others around her. Worthlessness, low self-esteem and internalization of the invalidation she experienced in the gifted program relate to her experience of Anorexia. Grace has an awareness of her difference from others throughout her life. She isolated herself and feared socialization, since she felt she would be required to "put on her face" and 99 mask her true self and complex i ty . H e r eating disorder is related to her restr ict ion o f her experience and isola t ion . She was able to f ind connect ion wi th others w h o also struggle throughout her experience o f eating disorder treatment and confront ing the issues at its root. H e r expectations o f perfection for herself, and to be "the best", contr ibuted to her determination to be perfect at her eating disorder. H e r determination to succeed, however , then became a determination to let go o f her eating disorder. She finds a contradict ion i n being grateful for A n o r e x i a i n her l i fe , as it brought w i t h it " h e l l " , pa in and struggle. Through her experience she has come to appreciate the value and purpose o f A n o r e x i a i n her l i fe . She feels that she has learned m u c h through her struggle and w i l l carry that w i s d o m throughout her l i fe . She acknowledges that the eating disorder forced her to stop, reevaluate and to gain the self-knowledge required to care for herself, to engage i n the w o r l d and relationships, to learn w h o she is and what she does and does not need. A n o r e x i a is the metaphorical "train wreck" that altered the course o f her l i fe and exper iencing. Just to have been able to have like a train wreck stop that and everything and be able to decide how I wanted to live my life it was really valuable. Mary "It's very annoying being a perfectionist, it really controls you, and it can drive you insane because you're never perfect, it's never perfect when you're a perfectionist. " M a r y ' s struggle w i t h A n o r e x i a is one o f searching for happiness, self-acceptance, self-esteem and the "perfect M a r y " . Th i s search and a quest for a phys ica l ideal , and cont ro l 100 of her body, promised her many things but instead created conflict within herself as she became controlled by her eating disorder. Feelings of despair, self-consciousness, and not being "good enough", worsened throughout her experience. She initially looked to her eating disorder as solution, a means to feel better about herself, and to distance herself from the incessant comparisons she made of herself to others. She was unable to find what she was looking for through Anorexia. "I don't know if it was the journey to find the perfect 'Mary' or what, but I didn 'tfind it." Mary began severe restriction of her intake, and excessive exercise in an effort to focus on herself, her appearance and physical performance by becoming more "fit". She experienced physical and emotional deterioration, became medically compromised, and was hospitalized. Her determination to succeed was present in her daily preoccupation with food restriction and exercise. She feared the control that the eating disorder had of her, but was trapped by conflict within herself and opposing dynamics which led her to fear gaining weight or losing any more, a "battle within [her] brain". Throughout her experience she remained aware of her physical emaciation and was distressed by her thinness, although she denied the severity of her health risk. She experienced fear and self-consciousness related to the physical deterioration of her body. She felt that a crisis of some kind would be the only means through which she may be loosened from Anorexia's grip. Fear- and hospitalization represent that crisis and a turning point in her struggle. In Mary ' s experience of Anorexia, restriction of her intake, her emotions and her experiencing by isolation from her family and peer relationships occurred. She 101 conceptualizes her eating disorder as an "ev i l " part of her brain, which "twisted reality", and took over her life. Anorexia "ridiculed" her and made her feel worthless, although it allowed her to cope with profound depression and emotional pain, which she continued to mask. She feels that her depression and negative self-concept were a "major factor in getting the whole eating disorder started". Throughout her experience she felt void of emotions, although the emotional numbness that she felt was preferable to her than the emotional pain and depression in her experience. / was very quiet and didn't show much, didn't have much emotion at all, I was kind of emotionless actually, more than anything. Fear motivated her to use the determination and focus she had utilized to engage in her eating disorder to fight it instead. Her expectations of herself to be "exceptional", to "succeed", and to be "perfect" were shadowed by her feelings of self-hatred and criticism. Competitiveness and perfectionism, which were underlying factors in her experience, presented a dilemma of inevitable failure as she sought to be good enough for herself. High expectations in all aspects of her life relate to a desire for happiness and self-acceptance, factors interconnected with coping through her eating disorder. If she could not be good enough for herself she sought happiness and esteem by meeting the needs of others. Mary sacrificed her self and her needs, which took its toll on her identity. 1 0 2 "it got to the point where I sacrificed myself to make other people happy... then it just got to the point where there was no me and I wasn 't really anything for myself anymore." Restriction of emotional expression was present in her experience of Anorexia and also in response to her eating disorder by others. She remarks on the "silence" of her family and friends through her struggle. She appears to feel that her family dynamics are not typical of those who experience disordered eating although she cites a family history of depression, and disordered eating as related factors. Mary relates giftedness to her experience of Anorexia through a connection to her continual search to accomplish and excel. Her poor self-esteem has not allowed her to internalize her successes and through her eating disorder she sought to compensate for her perceived inadequacies. "it can be like a black cloud over your head, and you keep striving but there's a point when you can't do any better than you already are. And that's when you look to other things to do better, to compensate for what you can't do better at." Mary has experienced anger at her self for allowing Anorexia into her life and giving it the opportunity to " k i l l " her when she should have "known better". She is cognizant of the irony related to how the idealized solution to her emotional pain, depression, and lack of self-acceptance and self-worth "backfired" and became a battle in itself. 103 A l t h o u g h M a r y has regained phys ica l health she continues to struggle. She bel ieves that her experience o f A n o r e x i a was purposeful and happened for a reason. She has come to appreciate the value o f the eating disorder i n her l i fe and what it has brought her i n c l u d i n g a stronger identi ty, self- knowledge and personal growth. "if it doesn 't kill you it makes you stronger! Almost literally." M a r y continues to search for the happiness falsely promised by A n o r e x i a . Feedback from Participants Situated structures were sent to each o f the participants. The response f r o m them was o v e r w h e l m i n g l y posi t ive , and none sought to clar i fy any themes or aspects o f their experience. M a n y reflected on how their experience had been captured fu l ly and that they d i d not want to change anything. Several commented that it had been a pos i t ive experience for them to see the essence o f their experience i n this format and that it had caused them to consider themes in their experience o f an eating disorder that they had not fu l ly understood or considered pr ior to now. General Structure: Final Themes and Sub-Themes T h e general structure o f the experience o f an eating disorder among the s ix gifted adolescent female participants fo l lows . Table 1 outlines the ma in themes and sub-themes w h i c h represent the core and c o m m o n themes o f the experience. E a c h theme and the associated sub-themes are described and excerpts f rom the participant in terviews are p rov ided to add depth and the voices o f the participants to the presentation o f the f ina l themes. 104 Tab le 1: T h e Exper ience o f an Ea t i ng Disorder A m o n g Gi f t ed Female Adolescents : M a i n Themes and Sub-Themes M a i n Themes Sub-Themes Negative Affect and Self-Perceptions, Emotional Pain and Deterioration Overwhelmed and Conflicted Fear Depression, Desperation and Hopelessness Anger and Frustration Guilt , Blame, and Burden Worthlessness, L o w Self-Esteem and Crit ical of Self Physical, Cognitive, and Emotional Deterioration Continuous Struggle Hospitalized/Medically Compromised Trapped and Pressured Conflicting and Opposing Dynamics Not Fitting: Incongruence and Awareness Differences Incongruence in the Family System Coping Through Engaging in the Eating Disorder Eating Disorder as a Solution Experience of Giftedness and Eating Disorder and/ or Struggle Expl ic i t ly Connected Heightened Awareness/Sensitivity Perfectionism- Striving to Attain "Perfect" Goal of Perfect Anorexia Expectations Determination and Focus / 105 Control and Restriction Personal Quest for Control Controlled by Others Controlled and Consumed by Eating Disorder Restriction of Intake Restriction of Emotions Restriction of Experience Awareness of Multifaceted Underlying Factors Experience the Eating Disorder as Not About Food or Weight Sacrifice, Defiance and Separation: O f Self and Identity, of Body, and of Needs Sacrifice Prioritize Needs of Others Defiance and Denial Separation and Dissociation Defining of Self and Identity Issues Experience of Eating Disorder Vo ice -Externalization of Eating Disorder Purposeful, Appreciated and Meaningful Experience Appreciation and Recognition of the Value of the Eating Disorder Experience Purpose and Meaning Eating Disorder as a Metaphor Searching Theme 1: Negative Affect and Self-Perceptions, Emotional Pain, and Deterioration The experience o f an eating disorder among the participants includes negative affect, negative self-perceptions, emot ional pain and deterioration. The profoundly negative feelings and perceptions are pervasive and relate to internalizat ion o f pa in f rom the environment , as w e l l the personal emot ional pain that resides w i th in the i n d i v i d u a l . T h e 106 deterioration that occurs among these young women is physical, cognitive and emotional and relates to a progressive worsening and escalation of the eating disorder experience. Esprit describes the scope of her pain that she internalizes from the world around her. The pain of finding your place in the world and the universe. Trying to... beyond yourself, trying to make sense of things, not understanding things, why things happen, unfairness. The conflict between our best intentions and what actually goes on in everyday life [begins to cry]. Sub-themes within this category represent specific factors that relate to negative affect and perceptions of self, as well as emotional pain and are part of the experience of an eating disorder for several participants. These sub-themes include: Fear: Depression, Desperation and Hopelessness: Anger and Frustration: Guilt, Blame, and Burden: Worthlessness, L o w Self-Esteem, Critical of Self; Continuous Struggle; and Hospitalized/ Medically Compromised. A l l participants referred to experiencing Fear. This is often related to a fear of a continuing struggle with their eating disorder, the eating disorder's severity, or the control that it has over them. Several participants describe a fear of letting go of the eating disorder, or of being themselves. Mary expresses her fear related to her emaciated physical state. "I did see myself as really skinny, it scared me ". Esprit describes her fear of the possibility of a life long battle with her eating disorder. 1 0 7 There are days when you ... you worry that oh my god is it always going to stay like this, I have always been like this, I am like this, I will always be like this. Feelings of Depression, Desperation and Hopelessness relate to the experience of Anorexia for most of the participants. Mary describes how depression is related to her struggle with her eating disorder. "the depression was a major factor in getting the whole eating disorder started". Grace describes the desperation, depression and hopelessness that she felt as she struggled to deal with her eating disorder and considered whether she could continue her life in its grips. "I'd get progressively depressed, depressed, and more depressed". I was just like I was so desperate to stop the pain... cause I just felt like I was in so much pain all the time and I was always thinking. And everything was always wrong. I felt like if I spent the night at home that I would get up in the middle of the night and try and bus downtown and get a gun because I felt just so desperate to stop thinking and to stop feeling all this pain of being sick. 108 Severa l participants referred to exper iencing A n g e r and Frustrat ion as an aspect o f their eating disorder experience. Feel ings o f anger and frustration were typ i ca l ly directed towards themselves for s truggling, harming themselves, hav ing begun to engage i n eat ing disorder behaviour , or cont inuing to struggle wi th eating disorder issues. A n g e r and frustration were also directed at others for confronting them or t ry ing to control their eating or exerc i s ing behaviours . Frustrat ion was also related to the irrat ional nature o f the eating disorder and h o w it cont inued to be present i n their l ives . Phoen ix refers to the frustration she experienced as she evaluates w h y the eating disorder mainta ined its place i n her l i fe . I'm doing this again and again and again and yet why? Why am I not doing it? Why is nothing getting solved? Feel ings o f G u i l t , B l a m e and Burden related to the experience o f A n o r e x i a among the majori ty o f the participants. M a n y o f the participants refer to feel ing gui l ty about the effect that the eating disorder has on those around them, feel ing b lamed by others or b l a m i n g themselves for their eating disorder, or feel ing that they are a burden to those around them. T h e majori ty o f the participants express feelings o f Worthlessness , L o w Sel f -Es teem, and are C r i t i c a l o f Self . T h i s sub-theme seems to reflect the part icipant 's negative feelings about themselves and devaluat ion o f their o w n worth . M a n y participants indicate fee l ing that they are not deserving, are harshly cr i t ica l o f themselves, or feel ing that they are never good enough. E m i l y and M a r y describe h o w worthlessness and l o w self-esteem relate to their experience o f their eating disorders. 109 I didn 'tfeel that I deserved to live ...I didn 't deserve to eat, I deserved to end up in hospital, I deserved to die. I'm just never good enough. And I always wanted to be better. C r i t i c i s m o f themselves also extends to what appears to be seeing themselves as out o f the ordinary, for example descriptions o f themselves that include " w e i r d " , "c razy" , "b izar re" or, "abnormal" , "too smart". T h e participants experience a progressive deterioration i n the phys ica l , cogni t ive and emot ional sense, and a worsening and escalation o f their eating disorder struggle. Participants reflect on a Cont inuous Struggle, w i t h their eating disorder and several cycles o f relapse, revert ing to us ing eating disordered behaviour to cope, and the burden o f a da i ly , moment- to-moment struggle wi th disordered eating cognit ions and behaviours . A fee l ing o f be ing defeated by the eating disorder is present in the experience o f many participants. T h e sub-theme o f be ing H o s p i t a l i z e d / M e d i c a l l y C o m p r o m i s e d is an aspect o f the experience o f the eating disorder for a l l o f the participants. A l l participants refer to the severity o f the phys ica l deterioration o f their bodies, and to their phys ica l health be ing c o m p r o m i s e d s ignif icant ly. W i t h the except ion o f one participant, a l l were hospi ta l ized for some length o f t ime, or on more than one occas ion as a result o f med ica l r i sk associated w i t h their eating disorder. T h e remain ing participant also suffered significant med ica l compl ica t ions and emergency med ica l interventions. 110 Theme 2: Overwhelmed and Conflicted The experience of an eating disorder involves feelings of being overwhelmed within themselves and also by external sources in the environment. There is a strong sense that their experience is too much to take, and a need to escape the feelings or situations that threaten to overwhelm them. Participants refer to being overwhelmed by many factors, for example being overwhelmed by their emotions, heightened sensitivities, and the state of the world around them. Participants also refer to internal opposing dynamics and conflict within themselves that relate to their eating disorder experience. Andrea describes being overwhelmed by her heightened sensitivities and emotionality. I wanted to shut it down just because I find that despite how much I don't want to be, I have always been very emotional, very in touch with things ... in some ways too much. But I just didn't want to handle things anymore. A salient sub-theme within this category includes specific reference by many of the participants to feeling Trapped and Pressured. Participants discussed feeling trapped or pressured by the expectations of themselves, or that others have for them or by their environments. Participants often express being trapped by their eating disorder, as Phoenix and Grace do here: It's like, if you want to get better then why are you still doing these things, why don't you just try harder. And it's like you can't, you just can't. I l l Just the pain of thinking all the time, of feeling like there was no way out because I did feel trapped. A l l participants describe C o n f l i c t i n g and Oppos ing D y n a m i c s throughout their eating disorder experience. T h i s represents feel ing torn, and the push and p u l l o f oppos ing forces w i t h i n themselves and i n response to their eating disorder. T h i s sub-theme represents the inner struggle that characterizes the experience o f disordered eating for the participants. M a n y participants refer to the inabi l i ty to let go o f their eating disorder despite want ing to, and acknowledge a conf l ic t that arises between the depth o f their exper iencing, yet focus on phys ica l attributes. Participants also describe a "love-hate" relat ionship w i t h their eating disorder, such as fearing the effects o f the eating disorder on their bodies and l ives , yet want ing to mainta in its role i n their l ives . S o m e participants describe the functions that the eating disorder serves i n their l ives as conf l ic t ing and opposing. A n d r e a describes h o w her eating disorder satisfied two opposite and oppos ing needs. T h i s oppos i t ion o f needs created confl ic t w i t h i n her as she struggled to understand her eating disorder and the role o f it i n her l i fe . / didn't really understand ... what I was doing because I wanted to be erased and to talk to no one and to be alone, and at the same time I wanted people to worry and to nurture me. Phoen ix describes the "contradictory" nature o f eating disorders and also describes her experiences o f be ing caught between the opposing forces o f want ing to recover and also want ing to remain engaged i n her eating disorder. 112 In my opinion, eating disorders are really contradictory things. Maybe you think one thing and do another and do one thing, think another I was fighting a whole bunch of different things. I was fighting getting better and I was fighting not getting better. Theme 3: Not Fitting: Incongruence and Awareness of Differences A l l participants refer to an awareness of how they often do not fit in their environments (i.e. family or peer group), or that they experience incongruence within themselves. Many participants refer specifically to incongruence between the eating disorder interventions that they received and their needs in those settings. Several participants also referred to how they were aware of a difference in their eating disorder experience in comparison to other young women whom they met that were also struggling with eating disorders. It seems that others also, at times, recognized their differences in their eating disorder experience and not fitting in. Phoenix describes her awareness of the differences in her eating disorder experience, which was noticed by other professionals, and how the differences relate to many of the interventions that she received which she felt were incongruent with her needs. It just felt like a totally different subject matter... It was like a different species of eating disorder almost. Esprit expresses how her eating disorder relates to the experience of not fitting in, and how her eating disorder was a means for her to fit in, in a more general sense. 113 There was always a kind of sadness and pain associated with not fitting in and also being chubbier than the other kids so maybe at some point I thought well maybe if I lose some weight... W h e n I asked Espr i t about her experience o f feel ing different she f in ished m y sentence w i t h the reply: [feeling different] is at the heart of a lot of my problems...if not... probably one of the most important factors. A l l participants explored fami ly factors that p layed a role in the experience o f the eating disorder. A l t h o u g h fami ly factors in a general sense were a predominant theme, the specif ic characteristics o f f ami ly related factors were less un i form. T h e most c o m m o n f a m i l y related factors are summar ized as an incongruent environment, and a f ami ly system not adequately meet ing the needs o f the young w o m e n exper iencing the eating disorder. T h i s element o f the eating disorder experience is represented i n the sub-theme, Incongruence i n the F a m i l y Sys tem. Incongruence exists i n the sense that the eating disorder represents something that is not w o r k i n g i n the f ami ly system, or incongruence between the needs o f the y o u n g w o m e n and the f a m i l y ' s capacity to meet them. Some o f the more specif ic c o m m o n factors relat ing to f ami ly include: feel ing blame, c r i t i c ized , control led , or responsible for the needs o f f a m i l y members . 114 Theme 4: Coping Through Engaging in the Eating Disorder A l l participants refer to how their experience involved coping through engaging in their eating disorder with various internal and external factors. Participants primarily refer to the eating disorder as a means to cope with emotional pain absorbed from the environment and that resided within them. Participants also refer to coping with pressure to live up to their potential, feelings of worthlessness, change, stress, and their reaction to the world through their eating disorder. E m i l y refers to the overwhelming emotional pain that she experiences and how her eating disorder experience involves coping. it was like being in the middle of a hurricane all the time, and so to try and deal with that, I would run and it hurt physically to run, and so I was able to take my concentration from concentrating on the stuff I didn't know how to deal with, into physically beating my body, cause I could deal with that. I could handle the pain of running, but I didn't know how to handle the pain of all the emotions. A s the eating disorder allowed the participants to cope, it also functioned a s a solution to something that the participants were searching for. The sub-theme, Eating Disorder as a Solution, reflects the participants' conceptualization of their eating disorder as bringing something to their lives that was absent or fulfilling an unmet need. The eating disorder was hypothesized to allow them to feel or experience something that they felt unable to before. The participants were often searching for something, for example, for happiness or to fit in 115 and the eating disorder was seen as a solut ion to those things. T h i s was often later recognized as a false promise w i t h w h i c h the eating disorder tempted the young w o m e n . Theme 5: Experience of Giftedness and Eating Disorder Explicitly Connected The participants speci f ica l ly related their experience o f an eating disorder to their giftedness wi thout prompt ing . Participants appeared to have various levels o f experience w i t h conceptua l iz ing h o w their giftedness fits w i t h their eating disorder experience. Severa l ident i f ied the connect ion between giftedness and eating disorders as important, a l though it was a relat ionship they continue to explore and attempt to understand. S o m e o f the young w o m e n describe their experience o f an eating disorder as an expression o f gifted issues, w h i c h they identify as self-doubt, pressure (internal and external), perfect ionism, worthlessness, depression, and heightened sensit ivit ies. M a n y participants felt that the depth o f their emot ional exper iencing and complex emot ional needs related to giftedness, and were not met or understood i n their environments. Phoen ix addresses h o w her giftedness contributed to h o w her eating disorder d i d not "f i t the m o l d " , and h o w the interventions she received d i d not meet her needs. Giftedness just puts a whole different spin on things. It's like, for one reason, doctors don't know what to do with you... at least for me. Espr i t refers to giftedness, " ins ight" and "capabi l i ty" as "your greatest f r iend or your greatest enemy". Espr i t exp l i c i t l y relates her experience o f A n o r e x i a to her giftedness and struggles w i t h the meaning o f the connect ion and how it contributes to the struggles that she 116 faces in her life. Esprit also considers the struggles that she sees amongst other gifted individuals, and questions whether they are all "doomed". The connection between the kind of increased sensitivity, self-consciousness, self-doubt, insecurity, perfectionism and being gifted, talented, successful... I think there is a connection with that and then the eating disorder is just an expression of the self-consciousness and perfectionism and that sort of thing that results when there are other contributing factors as well. One of the reasons that I am really excited about this research is because I think that it may have something to do with, that there is a connection between my sensitivity and kind of being more of like a sponge.. In between that and being more prone I guess to having problems, not just eating disorders but depression as well (sighs). A salient sub-theme that relates to participants' experience of their eating disorder and its relationship to giftedness is Heightened Awareness and Sensitivity. Many participants relate their giftedness to their awareness of "subtleties" in their environment, and a feeling of responsibility for the world and others around them based on their heightened awareness. In that sense several participants appear to feel the "weight of the world" on their shoulders, and to "perceive more or see more than others". The experience of Anorexia is specifically related to trying to escape, or being overwhelmed by this sensitivity and heightened awareness. Several participants identify internalizing and mirroring the needs of 117 others, while being extremely sensitive to change and the emotional environment around them. - Andrea refers to her sensitivity and internalization of the world around her. / guess I dunno its just that I find that as an individual I just feel like just a heavy weight of all problems in the world that I just like I don 'tfeel like I have to solve them but I just feel them and I experience them. Esprit also comments on how her sensitivities and perceptions of the world contribute to her eating disorder and the pain that she experiences in her life. That's why I think that anorexia is connected closely with my perceptions of the world or sensitivities and that's sort of what I mean by too much for my own good and maybe if I had less of that I wouldn 't have as much pain in my life. Theme 6: Perfectionism- Striving to Attain "Perfect" A n enduring theme throughout the experience of an eating disorder for all of the participants was perfectionism. Perfectionism is reflected in a need to be the best, or striving for perfection although never feeling good enough. Perfectionism is related to self-destruction, and eating disorders are seen as being another area of life that the participants could "control perfectly", or an area in their lives in which they could be "perfect". Perfectionism is conceptualized as "fueling" the eating disorder. Several participants refer to the relationship between perfectionism and giftedness, as well as relating perfectionism specifically to their eating disorder experience. 118 E m i l y ' s experience wi th pervasive perfectionistic thoughts and expectations o f herself is described: I shouldn 't have let myself be imperfect. I was not supposed to be letting myself make mistakes. M a r y describes h o w her need to be perfect threatens to o v e r w h e l m her, and is i n v o l v e d w i t h her eating disorder struggle. • Because you can't be obsessive about everything, you can't be perfect in everything, and when you're trying so hard to do that eventually you just kinda implode... A n d r e a describes h o w perfect ionism relates to inevitable self-destruction, w h i c h is h o w she conceptual izes her eating disorder experience. ...Being obsessive and perfectionistic, and all that kind of stuff... eventually it's a recipe for self-destruction. A sub-theme o f perfect ionism, the G o a l o f "Perfect A n o r e x i a " is present among the majori ty o f the participants. Several o f them exp l i c i t l y describe a desire to achieve "Perfect A n o r e x i a " or to be the "Perfect A n o r e x i c " . Part icipants ' expectations o f themselves to be perfect, and a dr ive towards perfect ionism, extend to their eating disorder experience. T h e y feel that i f they are go ing to have an eating disorder they strive to exce l at it, be perfect and the best at it . T h e goal o f "Perfect A n o r e x i a " also appears to relate to searching for something i n w h i c h they may experience "perfection", when they feel that they do not meet 119 standards of perfection in other areas of their lives. Grace explored how her eating disorder was something that she felt that she could be perfect at when she felt imperfect in other areas of her life Since I couldn't be anywhere close to perfect in any other areas of my life, eating was one area I could be "perfect", and I felt like that too. E m i l y describes her determination to be the "Perfect Anorexic": I was going to be the ultimate Anorexic. I was going to be the Anorexic of all or the Anorexic of all Anorexics. The sub-theme Expectations is prevalent throughout all of the participants' experience of their eating disorder. Several participants explore expectations that they have of themselves and also that others have of them. Expectations that they have of themselves are often extremely high, perfectionist, and relate to expectations of being extraordinary, to succeed, to excel "beyond average" and to live up to an "image" of themselves that they envision. Among some of the young women the expectation that they should be able to recover more quickly than others, or that they should be able to "figure out" the eating disorder, is present in their experience. Expectations from others are often related to being perfect, to conform, or to be different than they are. Esprit describes how expectations, perfectionism, and trying to live up to the image that she had created, relate to her experience of Anorexia. 120 I think it is just a lot of expectations. I don't know if... it is perfectionism. I think that it has something to do with my eating disorder is that I am trying to live up to this image of me. A f inal sub-theme that relates to perfect ionism is Determinat ion and Focus . Determina t ion and focus often relate to both the eating disorder dynamic and also a quest to exce l , achieve and accompl i sh . The eating disorder appears to relate to achievement and exce l l i ng i n another aspect o f their l ives . W h e n they cou ld not a lways achieve or exce l , the eating disorder functioned to meet that need. T h e same under ly ing factors that p rov ided the dr ive for achievement propel led the eating disorder. A n d r e a articulates how her determination and focus to succeed relate to her eating disorder as they also do to other areas o f her l i fe . that was a goal that I was willing to do anything at all costs to meet.... It wasn't so much that I wanted to be skinny, or I wanted to be this, it's just that at all costs I was going to be successful at something and it didn't really matter how I had to get there... A n d r e a also describes how her determination and focus i n other areas o f her l i fe relate to engaging i n her eating disorder behaviour and mindset. When at those times in my life when um I sort of start to slip... I find those ... are the times of my biggest success. 121 Theme 7: Control and Restriction Control and restriction represents a prevalent theme throughout all of the participants' experience of Anorexia. The need for control, the associated feelings and reinforcement, feeling controlled by others, and also being controlled by the eating disorder itself are important aspects of control in the eating disorder experience. The sub-themes Quest for Personal Control, Controlled by Others, and Controlled and Consumed by the Eating Disorder relate specifically to the control dynamics that are present in the participants' experience of Anorexia. The sub-themes Restriction of Intake, Restriction of Emotions, and Restriction of Experience, further elaborate on participants' experience of control and restricting and the ways in which it exists in their lives and eating disorder experience. The Quest for Personal Control is a factor that is consistently described throughout all of the participants' experiences. This control-is often accompanied by feelings of power and satisfaction. Control as it relates to the eating disorder is often described as searching for the one thing that they felt that they could control when all other aspects of their lives felt out of control. Control of their body, weight and food intake represents a need for personal control, the basis of which resides outside of the eating disorder. The quest for personal control is also a response to the perceived control by others that they experience in their environments. Participants also experience conflict within themselves in their quest for control through their eating disorder, and describe the fight to regain control back from the eating disorder itself. Resistance to eating disorder treatment and interventions is another example of trying to maintain the feelings of control sought through the eating disorder. Grace describes her needs for control and how it relates to her eating disorder experience. 122 It was probably something I could control when I was just so scared that my life was uncontrollable. E m i l y articulates the force through which she attempted to prove to herself and others that she had control in her life. I was taking control myself I felt, and in a way ... nobody could take away from me, this was my area, I had control, and I was proving to the world that I had control over myself. Many of the participants describe experiencing feelings of power, satisfaction, superiority and energy from the control they gained through their eating disorder. Grace describes how the eating disorder and control of her body made her feel superior to others. Because I could control myself, my hunger, my body, it made me feel superior to others. Being Controlled by Others is another sub-theme related to control dynamics referred to as an aspect of the eating disorder experience for the participants. Many of the experiences of feeling controlled by others are responded to with anger, resentment, an increased need for control, or an increase in the eating disorder behaviour. Experiences of being forced to eat, gain weight or reduce or restrict activity levels are also frequently described as being controlled by others. Several of the participants actually comment on how 123 they needed to g ive up control and to have others control them and their eat ing to beg in to chal lenge their eating disorder and to attempt to move beyond it. T h e experience o f be ing Con t ro l l ed and C o n s u m e d by the E a t i n g D i so rde r is also present. T h e sense that the eating disorder was more powerful than they were, or that it was an "unstoppable" force, ho ld ing them captive, was described. There is a sense that the eating disorder was i n control and "choreographed" every thought and behaviour . A l t h o u g h the eating disorder began for most o f the participants as a means through w h i c h they sought personal contro l , it then began to take control o f them and their entire l ives . T h e i rony o f this relat ionship is present in many o f the part icipants ' consciousness. T h e y recognize the i rony related to the " so lu t ion" then becoming a problem. A n d r e a describes the eating disorder 's control o f her body and m i n d : ...under that extreme starvation, and having it... for so long, I wasn 't able to decipher anything except that the eating disorder had run my body and my mind. A frequent behaviour and core sub-theme i n the part icipants ' experience o f the eating disorder is Res t r ic t ion o f Intake. A s a l l o f the participants experience A n o r e x i a Ne rvosa , they describe signif icant restrictive eating behaviour, malnutr i t ion, and phys i ca l emacia t ion . The restrict ion o f intake among a l l participants, al though variable, was typ i ca l ly extreme and i n many reached levels o f minute-to-minute preoccupation and taking i n l i t t le or no nourishment. Res t r ic t ion o f intake seems to have begun as a diet or reduction o f food intake and then progressed and escalated to starvation. M a n y participants related their restriction o f food, their preoccupations, and their eating disorder experience speci f ica l ly w i th Rest r ic t ion o f Emot ions . Part icipants actual ly 124 spent m u c h more t ime and energy descr ibing their restriction o f emotions through their eating disorder experience rather than their specific eating disorder behaviours . A sense o f be ing v o i d o f any emotions and numbness was described. Several participants also exp lored h o w emot iona l restrict ion and "s i lence" i n their f ami ly environments has impacted them. E m i l y describes a significant di f f icul ty in exper iencing her emotions. She speaks o f her emotions as something she holds at arms length and looks at rather than fee l ing them. I've had such a struggle with letting myself feel my emotions.. .1 don't let myself feel my emotions. A n d r e a relates her restriction o f her intake and eating disorder experience to restrict ion o f her emotions. Pulling away from my emotions I also pull away the physical need to eat and stuff like that. A l s o related to the theme o f restriction is the sub-theme, Res t r ic t ion o f Exper ience , w h i c h is conceptual ized as restriction i n connections wi th others, i so la t ion , and wi thdrawa l . F o r some participants, their desire to wi thdraw and isolate was facil i tated by their eating disorder and for others restricted exper iencing was a result o f their eating disorder experience. Theme 8: Awareness of Multifaceted Underlying Factors: Experience the Eating Disorder as Not Primarily Related to Food or Weight T h e participants are a l l cognizant o f the complex and multifaceted under ly ing factors that underl ie their eating disorder experience. A focus on these factors is emphas ized i n the 125 descriptions o f their experience o f A n o r e x i a rather than a focus on seeking thinness or a phys ica l ideal . T h e young w o m e n see past the presenting preoccupations and behaviours associated w i t h food and thinness, and specif ical ly address the existence o f c o m p l e x issues that underl ie their eating disorder. T h e majori ty o f the participants specif ical ly address their eating disorder as not be ing about food or weight. T h e de-emphasis on weight or food issues is reflected i n the sub-theme Exper ience the E a t i n g Disorder as N o t A b o u t F o o d or Weigh t . T h e participants are aware o f the contradict ion between their behaviour and the under ly ing contr ibut ing factors. Participants identify that they i n fact d i d not want to be thin and were distressed by their phys ica l state and emaciat ion. In one instance, a focus on phys ica l attractiveness and thinness created a significant l eve l o f dissonance and distress w i t h i n the i n d i v i d u a l as she sought to satisfy m u c h more existential and deep felt needs. Theme 9: Sacrifice, Defiance and Separation: O f Self, of Body, and of Needs F o r the participants, the experience o f an eating disorder is conceptual ized as a sacrif ice o f body , o f self, and o f personal needs, by p r io r i t i z ing and meet ing those o f others before their o w n . -f-In many ways, the eating disorder is a defiance o f the phys ica l b o d y and its needs, as w e l l as a defiance o f environmental forces. Issues related to identi ty are part o f the eating disorder experience. Participants often sacrif iced their sense o f self or identi ty through their struggle. T h e y refer to both def ining themselves through the eating disorder, and also attempting to separate it f rom themselves. T h i s can occur s imul taneously as the / • 126 young w o m e n struggle to f ind w h i c h parts o f their personalities and l ife are t ruly their o w n , and w h i c h other elements o f their experience are created by A n o r e x i a . Sacr i f ice is a sub-theme explored throughout the eating disorder experience. Part icipants refer to a sacrifice o f themselves, their needs, and their bodies for various purposes. In some o f the young w o m e n sacrifice is reflected in a pr ior i t iza t ion o f the needs o f those c lose to them, w h i l e i n others the needs o f the larger c o m m u n i t y or the people o f the w o r l d are pr ior i t i zed . A predominate sub-theme i n the participants ' l ives pr ior to the eating disorder experience, as w e l l as throughout the experience is the Pr ior i t i za t ion o f the Needs o f Others. T h e young w o m e n also experience a heightened awareness and sensi t ivi ty to the needs o f others w h i c h appears to relate to pr ior i t iza t ion o f other's needs and fee l ing responsible for those needs. S o m e o f the participants appear to have felt that they d i d not deserve to meet their o w n needs, or to have their needs met by others. The young w o m e n often in ternal ized and mi r rored the emot ional states o f others, p rov id ing what others needed f rom them i n the moment , w h i l e sacr i f ic ing their o w n needs at that t ime. Several participants also describe a wi l l ingness and mot iva t ion to recover f rom their eating disorder for others rather than for themselves, another example o f p r io r i t i z ing the need o f others over their o w n . E m i l y describes her sensi t ivi ty to, and pr ior i t iza t ion of, the needs o f those around her: I could tell if my mum was sad, and I would try and push away my own needs, even when I was very small. Espr i t describes her mot iva t ion to recover for others' aside f rom herself: "If I can't eat for me then at least I can eat for the world". 127 Defiance and D e n i a l are consistently described throughout the part icipants ' experience o f A n o r e x i a . Def iance and denial o f needs, and also the eating disorder as an act o f defiance is described. Participants speak o f deny ing their b o d i l y needs, their body itself, death, and the severity or health r isk related to their eating disorder. T h e eating disorder as an act o f defiance is often a response to a feel ing o f be ing control led, or defying others i n the on ly w ay that they felt that they cou ld . Several participants see their eating disorder as an act o f defiance a typical o f adolescent presentation. Rather than act ing out i n an overt show o f defiance, they are in ternal iz ing and defying through the use o f their o w n body and starvation. A n d r e a describes her eating disorder as an act o f defiance: / knew that what I was playing with was dangerous but I still did it anyway. Sort of like a, I guess an act of defiance. Separation and Dis soc ia t ion are also related to the eating disorder experience for many o f the participants. Participants sought to experience themselves as outside o f their l i fe or consciousness, or feel that way as a result o f their eating disorder. There was a sense that the phys i ca l and psych ic realms can be separated. T h i s dissociated or separated state was described as either a goal or consequence o f the eating disorder. A n d r e a also articulates h o w her eating disorder a l l owed her to dissociate and separated herself f rom her body and other elements o f her w o r l d . / didn 'tfeel, I just kind of wanted to get away from everything and, just kind of separate myself from the physical world I guess. 128 I felt like I was carrying the weight of the world and I thought that if you could defy everything and separate mind from body then I wouldn 't have to deal with it anymore. D e f i n i n g o f S e l f is a sub-theme that reflects the participants ' experience o f def in ing themselves through hav ing an eating disorder or being unable to separate themselves f r o m it. A n d r e a c lear ly expresses how she defines herself by her eating disorder: I think about it and I think well eventually you kind of become defined by it and you realize well if I don't have that then who am I kind of thing. And it's something that I'd like to get rid of but, like, I don't know, I think for me there never really will be a full recovery but I'm willing to live with that, so, yeah. Espr i t describes how she struggles w i th seeing herself as separate f rom her eating disorder, and also considers h o w she is defined by it: On one hand I can so do this, I have had a lot more difficult things in my life and it's no problem but on the other hand what if the disease is stronger than me. Whatever me is and whatever the disease is and however the two go together. A l t h o u g h participants may define themselves, or parts o f themselves, through their eating disorder, they also refer to external iz ing their eating disorder f rom themselves and several refer spec i f ica l ly to an "eating disorder vo ice" . The sub-theme, Exper i ence o f E a t i n g Diso rde r Vo ice -Ex t e rna l i z a t i on o f Ea t ing Disorder , reflects the participants ' experience o f externa l iz ing the eating disorder f rom themselves and reference to their eating disorder vo ice . 129 T h e vo ice is o n l y a conceptual izat ion and does not reflect an actual vo ice that they hear concretely. It is often the way that the young w o m e n think o f the external ized representation o f their eating disorder and the " two parts" o f their selves. The eating disorder vo i ce is seen as powerfu l and often mal ic ious , destructive and manipulat ive . Phoen ix attempt to describe her eating disorder vo ice : I don't know how to describe it. It's like... it's not like a schizophrenic kind of actual voice that you hear, it's more like a thought but it's in, it's not always in words, it's kind of just a feeling...but it's still, it's kind of words and it's kind of not... but it's always there. It's like there's two parts to me, that's what it was like. Theme 10: Appreciated, Purposeful, and Meaningful Experience In addi t ion to the ove rwhe lming negative and painful experiences associated w i t h the experience o f A n o r e x i a described by the participants, they also reflect on an appreciat ion and recogni t ion o f the value o f the eating disorder i n their l ives . A l l participants emphasize the purpose and meaning associated wi th the eating disorder experience. A l t h o u g h not an experience that they w o u l d ever w i s h someone else to go through, it is one that many w o u l d not erase f rom their l ives i f g iven the opportunity. A n d r e a reflects on her experience o f her eating disorder hav ing purpose and meaning i n this excerpt and h o w although it is an experience she w o u l d not w i s h on someone else, it is one that she feels that she needed to go through i n order to recreate herself. Andrea: ... it was something that, it's like an awful thing to go through but I wouldn 't take it back for anything, ...I learned a lot about myself and 130 continue to learn... I definitely wouldn 't wish anything that I've done to myself on anyone else. Alison: But it's something that you wouldn't take back for your own experience? Andrea: Definitely. Alison: mmm. Can you tell me more about this?... Andea: I guess, the theory of, you need to self-destruct before you can excel. I always found that like, oh I don't know it makes sense in my head, uh, that, I don't know I just found that like it was almost the way that I had recreated myself. Like I've gone through that and come out kind of, I don't know, better. Still struggling but, it just kind of like, I don't know, I just kind of came out as an individual, not really caring about things, not really getting caught up in the things that I always found so important, like people my age ... T h e sub-theme Apprec i a t ion and Recogn i t ion o f the V a l u e o f the E a t i n g D i so rde r Exper ience is important to the experience o f an eating disorder among a l l the participants. T h e eating disorder has brought struggle and gr ief to the l ives o f the young w o m e n , but there is also a sense that it has p rov ided them wi th an opportunity to learn about themselves, or has provide self-understanding and strength. The eating disorder is appreciated and met w i t h a sense o f value, gratitude, and o f hav ing been wor thwhi le . M a r y comments on the strength she gained through the experience o f her eat ing disorder: "if it doesn 't kill you it makes you stronger! Almost literally." 131 Phoen ix conceptualizes and appreciates her eating disorder as a l ight: I felt like I was on this road and there was this end there was this light at the end that would make things clearer. Grace explores h o w her eating disorder experience caused her to learn things as an adolescent that many adults may not have learned: That's kind of a weird thing, it was like a living hell for a whole year but coming out the other end of it I've learned so much ... Just to have been able to have like a train wreck stop that and everything and be able to decide how I wanted to live my life it was really valuable. Purpose and M e a n i n g i n the eating disorder experience is an important sub-theme that also relates to the appreciation o f the value o f the eating disorder experience. Part icipants e x p l i c i t l y refer to feel ing that their eating disorder experience was purposeful , had mean ing in their l ives , and was something that they needed to go through. T h e young w o m e n often explore the purpose and meaning, as they attempt to make sense o f the experience o f the eating disorder i n their l ives . Phoen ix often referred to her understanding o f the purpose and meaning o f her eating disorder. She c lear ly indicates that i n f inding and accepting the purpose o f her eating disorder she experienced more freedom f rom it. 132 I think, again it was like most other people happened due to a cause and mine was for a purpose... this was meant to happen, it just didn't happen, it was meant to happen. it didn't happen so much from a cause as for a purpose.. .a person's mind like, it can either be, it can be stuffed with things that don't really mean anything, just a bunch of surface things but then with the eating disorder it kind of cleared it all. It was like whoa, I can see now. Just see everything in a total different light. Ea t ing Disorder as a Metaphor is a sub-theme that reflects the way i n w h i c h several o f the participants conceptual ize their eating disorder as a metaphor for something else. E m i l y describes h o w her eating disorder was not about thinness but was a metaphor for her desire to take up less space in the w o r l d : it's not really about my body at all, even when I was most sick, and depriving myself of food, it wasn 't because I wanted to be thinner, it was because I wanted to take up less space, I wanted to be less... in the way,... less a bother. And the only way to do that would be to take up less space in the world. A n d r e a examines how her eating disorder represents a coldness o f m i n d , body and spirit . I'd say that when I was in I guess peak starvation I was very cold, urn emotionally and spiritually and physically. 133 T h e sub-theme Searching relates to how may o f the participants were searching for something through their experience o f an eating disorder. The search is seen as a journey towards something. Somet imes they found what they were searching for; i n other instances it continues to elude them. 134 C H A P T E R V D i s c u s s i o n T h i s study describes the core and c o m m o n themes o f the experience o f an eating disorder among s ix gifted female adolescent participants, us ing data gained through in-depth phenomenologica l interviews. A situated structure was developed for each i n d i v i d u a l participant, based on the predominant themes i n their personal experience. T e n m a i n themes emerged f rom the data w h i c h inc luded: 1) Negat ive Af fec t and Self-Percept ions, E m o t i o n a l P a i n , and Deter iorat ion, 2) O v e r w h e l m e d and Conf l i c t ed , 3) N o t F i t t ing : Incongruence and Awareness o f Differences, 4) C o p i n g Through E n g a g i n g in the E a t i n g Disorder , 5) Exper ience o f Giftedness and Ea t ing Disorder and/or Struggle E x p l i c i t l y Connec ted , 6) Per fec t ion ism-St r iv ing to A t t a in "Perfect", 7) C o n t r o l and Res t r ic t ion , 8) Awareness o f Mul t i f ace ted U n d e r l y i n g Factors, 9) Sacr i f ice , Def iance and Separation: O f Self , o f B o d y , and o f Needs , 10) Apprec ia ted , Purposeful and M e a n i n g f u l . In this chapter, the signif icance o f the f indings w i l l be explored i n l ight o f the literature rev iewed and the methodology u t i l i zed , and w i l l also be discussed i n terms o f gifted young w o m e n and adolescents who may experience eating disorders. T h i s d iscuss ion w i l l also address what impl ica t ions the study may have for future research, psychoeducat ion, and psychotherapeutic practice. The subjective exper iencing o f the researcher is also considered, a long w i t h noteworthy observations about the sample and f indings. Significance of Findings in Light of Previous Research A d iscuss ion o f the f indings as they relate to previous research is cha l leng ing for this study. A s ment ioned previous ly , although specif ic literature pertaining to gifted ind iv idua l s 135 w h o experience eating disorders is sparse, the literature i n each o f the fields o f giftedness and eating disorders is vast. F o r the purposes o f this d iscuss ion, some o f the general topics addressed i n the literature review w i l l be explored concise ly , w h i l e more specif ic attention w i l l be pa id to areas i n w h i c h the current research f indings direct ly relate to literature reviewed. T h e p r imary focus w i l l be on previous literature specif ic to eating disorders among gifted adolescents. Conceptualisations of Giftedness T h e fact that the participants exp l i c i t l y related their eating disorder experience to aspects o f be ing gifted is o f particular interest. W i t h o u t be ing prompted, the participants discussed their giftedness, its association w i t h their eating disorder, and the specif ic aspects of giftedness that create pain and struggle i n their l ives . B y virtue o f be ing aware o f the purpose and participant selection cri ter ia o f the study, participants m a y have been more cognizant o f the relat ionship between giftedness and eating disorders. T h e young w o m e n appeared to have had va ry ing levels o f experience i n discussing their giftedness as it relates to their eating disorder. S o m e seemed to see giftedness as a def in ing characteristic i n their l ives and eating disorder experience, and more o f a way o f be ing i n the w o r l d than a trait. F o r other participants, cons ider ing h o w giftedness related to their eating disorder appeared to have been more o f a new venture. Giftedness as a construct is diff icul t to define concretely. T h e literature r ev iew emphasizes this point, and provided a br ief sample o f some o f the current conceptual izat ions o f giftedness. Par t icular ly salient i n the experience o f some o f the participants, and i n the way they related their o w n experience o f giftedness to their eating disorder, are the interpersonal, intrapersonal and existential intell igences as conceptual ized by V o n K a r o l y i , 136 R a m o s - F o r d and Gardner (2003). The young w o m e n do not typ ica l ly speak o f their cogni t ive intel l igence, or academic abi l i ty , but place more emphasis on their keen ly attuned interpersonal and intrapersonal abil i t ies when discuss ing their giftedness. V o n K a r o l y i , R a m o s - F o r d and Gardner have described a ninth, as yet unconf i rmed, existent ial inte l l igence as i n v o l v i n g "an interest and concern wi th ult imate issues" and "ponder ing the fundamental questions o f existence" (p. 102). Fee l i ng the "weight o f the w o r l d " , existential quest ioning, and exper ienc ing emot iona l pain f rom their environment, was a s imi la r theme apparent i n many o f the young w o m e n ' s descriptions o f their eating disorder experience. Heightened sensitivities and awareness referred to as psych ic overexci tabi l i t ies are discussed by many theorists and researchers i n the f i e ld o f giftedness (e.g. A c k e r m a n & Paulus , 1997; Bouche t & F a l k , 2001; Jackson, 1995; Jackson & Peterson, 2003 ; Schu l t z & D e l i s l e , 2003; S i lve rman , 1994, 1998; P i e c h o w s k i , 1997, 2003). The Exper i ence o f Giftedness and Ea t i ng Disorder and/or Struggle E x p l i c i t l y Connec ted theme, and the sub-theme Heightened Awareness /Sens i t iv i ty relate to psych ic overexci tabi l i t ies . Jackson and Peterson (2003) address the relationship between overexci tabi l i t ies and psycho log ica l distress among gifted adolescents, as w e l l as how various traits contribute to gifted adolescents ' feelings o f be ing "out o f sync" or "at odds wi th their various contexts" (p. 177). T h i s sense o f not f i t t ing i n , or being at odds wi th various contexts was c lear ly descr ibed i n the theme N o t F i t t ing : Incongruence and Awareness o f Differences. It also relates to the C o p i n g Through E n g a g i n g i n the Ea t i ng Disorder theme, as many o f the participants describe cop ing w i t h elements o f their giftedness, and feelings o f incongruence through their eat ing disorder. 137 Specific Literature Related to Eating Disorders Among Gifted Adolescents A s prev ious ly mentioned, the specific literature related to eating disorders among adolescents is currently not w e l l developed. Th i s study contributes m u c h to the f i e ld o f giftedness, as it spec i f ica l ly examines an area that is a l luded to as important, or i n need o f explora t ion by a number o f recognized experts (i.e. Ga t to -Waldon , 1999; Jackson & Peterson, 2003; Peterson, 1998; Garner, 1991). T h e literature that is specif ic to characteristics o f gifted ind iv idua l s w h o experience eating disorders can now be examined i n l ight o f the f indings o f this study. Spec i f i ca l ly , several o f the themes that emerged relate to characteristics o f giftedness that theorists and researchers often related to eat ing disorder r i sk factors, such as perfect ionism, determination to achieve, sensit ivi ty, p r io r i t i za t ion o f the needs o f others, and l o w self-esteem. S i l v e r m a n (1994), K e r r (2000) and K e r r and N i c p o n (2003) br ief ly ment ion the societal pressures on gifted adolescent females to meet socia l expectations o f beauty and attractiveness. T h e y suggest that gifted adolescents may be par t icular ly adept at p i c k i n g up on societal expectations and pressures related to thinness, weight and appearance preoccupat ion, and m a y therefore be more at r isk for eating disorders. Cont ra ry to these ideas, the gifted adolescents i n this study, for the most part, neglected descript ions o f societal pressures or a search for phys ica l ideals or thinness in descr ibing their eating disorder experience. T h e young w o m e n instead exp l i c i t l y point out that their eating disorder experience was not about these factors, as has been addressed i n the sub-theme Exper i ence Ea t i ng Diso rde r as N o t A b o u t F o o d or Weigh t . In many o f the cases where the eat ing disorder d i d relate to a search for a phys ica l ideal , it was acknowledged that this created a fee l ing o f dissonance, as it was not in keeping w i t h their conscious values and depth o f 138 exper iencing. One participant appeared very susceptible to societal messages, and focused m u c h attention on her search for a phys ica l ideal , but this characteristic was inconsistent w i t h the majori ty o f the data. S i l v e r m a n (1999) br ief ly alludes to a relationship between giftedness, per fec t ionism and a possible predisposi t ion to eating disorders among gifted adolescents. G a t t o - W a l d e n (1999), Garner (1991), and L e r o u x and Cuffaro (2001) a l l emphasize perfec t ionism as a factor related to eating disorders among gifted or h igh ly academica l ly able adolescent females. T h e pervasive perfect ionism i n v o l v e d in the eating disorder experience among these gifted young w o m e n is out l ined i n the theme, Per fec t ion ism-St r iv ing to A t t a i n "Perfect", and was emphasized by a l l participants as an important component o f the experience o f A n o r e x i a . Sub-themes o f the Perfec t ionism theme inc lude: a G o a l o f "Perfect A n o r e x i a " , Expec ta t ion (of self and others), Determinat ion and Focus . Garner (1991) identifies many r isk factors for eating disorders that m a y relate to gifted adolescents ' experience. H e described possible factors in f luenc ing the development o f disordered eating among gifted adolescents such as compet i t ive settings, and treating weight loss as "another area for d i sp lay ing personal competence" (p. 53). These predisposing factors refer p r imar i l y to the participants ' experience o f A n o r e x i a described i n the Per fec t ion ism theme. W h i l e the participants do not speci f ica l ly refer to competi t iveness or compet i t ive settings, determination and focus, and a quest to achieve and exce l were aspects o f the eating disorder experience for the participants. A quest for "Perfect A n o r e x i a " met achievement needs when the participants felt inadequate i n others areas o f their l ives . T h e i r eating disorder as an area to display "personal competence" is described more comple te ly i n the sub theme, G o a l o f "Perfect A n o r e x i a " . Garner also identifies l o w self-esteem as another 139 predisposing factor that may place gifted adolescents at r isk for an eating disorder. T h i s emerges i n the sub-theme, Feel ings o f Worthlessness, L o w Sel f -Es teem and C r i t i c a l o f Self , and is related to the l o w self esteem r isk factor noted by Garner (1991). O v e r a l l , the r i sk factors suggested b y Garner represent a select sub-section o f the experience o f an eat ing disorder among the participants i n this study. One theme (Perfect ionism), its sub-themes, and one addi t ional sub-theme (Worthlessness, L o w Sel f -Esteem and C r i t i c a l o f Self) account for the majori ty o f factors c i ted by Garner. B a s e d on c l i n i c a l experience and anecdotal evidence, Ga t to -Walden (1999) suggests that among her gifted clients s truggling w i t h disordered eating, several characteristics are c o m m o n . These characteristics inc lude a "personal identity that has d i sowned be ing gifted, debi l i ta t ing perfect ionism, excessive need to please others, experience o f i so la t ion and loneliness, stressful transition dur ing the onset o f the disorder and f a m i l y dynamics w h i c h may inc lude: overprotect ion, enmeshment, perfectionistic f ami ly standards and abuse or addict ive behavior" (p. 119). Several o f the characteristics that Ga t to -Walden refers to were present i n these f indings i n some way, although several characteristics that were noted b y Ga t to -Walden were not found i n the current study. The "excessive need to please others" noted by Ga t to -Walden may be reflected i n the sub-themes, Expecta t ions , and Pr io r i t i za t ion o f Needs o f Others. He re participants describe not so much a need to please as a heightened awareness, internal izat ion, and pr ior i t iza t ion o f the needs o f others. G a t t o - W a l d e n notes " i so la t ion and lonel iness" as often be ing experienced by gifted clients w i t h eating disorders, and this is congruent w i t h the sub-theme, Res t r ic t ion o f Expe r i ence -Wi thd rawa l and Isolat ion. Ga t to -Walden also l inks stressful transitions at onset and specif ic f a m i l y factors to the experience o f an eating disorder among gifted clients. N o stressful transitions were 140 emphasized, and the f a m i l y characteristic, "perfectionist ic standards" is the on ly factor w h i c h is related to i n the f indings o f the current study. Contrary to Ga t to -Walden ' s inference that gifted clients w h o experience eating disorders have "d i sowned be ing gif ted", the majori ty o f the participants i n this study speci f ica l ly acknowledged their giftedness, and related many gifted quali t ies to their experience o f an eating disorder. In some ways Ga t to -Walden (1999) has described characteristics or factors that were present i n the current f indings . O n the whole , however , I f ind significant differences i n the essence o f the emot iona l t u rmo i l , the ways that giftedness may relate to the experience, or how the eating disorder a l lows young w o m e n to cope w i t h elements o f their experience. The factors that G a t t o - W a l d e n suggests are central factors related to eating disorders among gifted clients can be accounted for b y a sub-section o f the current research f indings. Despi te the weakness o f the sources on w h i c h L e r o u x and Cuffaro (2001) suggest factors that overlap h igh academic abi l i ty and eating disorders, several correspond i n some way to the current research f indings. L e r o u x and Cuffaro cite hypersensi t ivi ty , w h i c h m a y be s imi la r to the Heightened Awareness /Sens i t iv i ty sub-theme, persistence, competi t iveness and h igh achievement corresponding to the Determinat ion and Focus sub-theme, and perfect ionism c lear ly corresponding to the Perfec t ionism theme. H a v i n g an introspect ive and intui t ive nature, intensity, and exci tabi l i ty may correspond to the Exper i ence o f Giftedness and E a t i n g Disorder E x p l i c i t l y Connected theme and/or the Heightened Awareness /Sens i t iv i ty sub-theme, and f ina l ly conscientiousness c o u l d be seen as s imi l a r to the Pr io r i t i za t ion o f the Needs o f Others sub-theme. Factors seen as over lapping ment ioned by L e r o u x and Cuffaro that were not indicated in the research f indings inc lude: 141 impuls iveness , h igh I Q , academic excel lence, precocious behaviours, and hypermatur i ty (p. 113). Societal Pressures, Self-Esteem, Perfectionism and Personality Factors Pr io r to conduct ing this study, the influence o f socia l pressures, self-esteem variables, and perfect ionism were a l l suggested as factors that c lear ly intersected research i n both the giftedness and eating disorder fields. Personal i ty and r isk factors examined i n literature pertaining to eating disorders among adolescents were also br ief ly explored . E a c h o f these areas can be br ief ly i l lumina ted through the f indings o f the current study. T h e effect o f societal pressures related to thinness, beauty and images o f femin in i ty on disordered eating among adolescents is addressed i n both gifted and eating disorder literatures (e.g. K e r r , 2000; Sands & H o w a r d - H a m i l t o n , 1995; S i lve rman , 1994; Slater, Guthr ies & B o y d , 2001). The susceptibi l i ty and r isk that is associated w i t h eating disorders among both gifted and non-gifted adolescent populat ions are explored i n current literature. A s p rev ious ly ment ioned, this aspect o f the eating disorder experience d i d not t yp i ca l ly emerge through the research f indings. W h a t d i d emerge through the f indings were the theme, Awareness o f Mul t i f ace ted U n d e r l y i n g Factors, and the sub-theme, Exper ience o f E a t i n g Di so rde r N o t A b o u t F o o d or Weigh t . Participants speci f ica l ly referred to complex under ly ing factors, many o f w h i c h relate to other themes. A de-emphasis on thinness, and fee l ing personal distress as a result o f phys ica l deterioration and emaciat ion was present i n the experience o f many participants. In one instance a participant ident i f ied a preoccupat ion w i t h her appearance. T h i s remains an inconsistent aspect o f the data as a who le . Ano the r participant discussed her vulnerabi l i ty to societal messages, but was over t ly distressed and 142 experienced conf l ic t w i t h i n herself as a result o f the incongruence between that focus and her personal values and depth. M u c h o f the literature rev iewed pertaining to self-esteem or self-concept variables among gifted adolescents contains controversial f indings (e.g. Ga l lagher 2003; H o g e & R e n z u l l i 1993; L e a - W o o d & Clun ies -Ross , 1995; Niehart , 1999). Whether gifted students experience higher or lower levels o f self-esteem, or more posi t ive or negative self-concept, appears to relate to the measures used, the ways i n w h i c h the constructs are operat ional ized, and whether soc ia l and academic self-concept is differentiated. Literature that addresses eating disorders among adolescents typ ica l ly cites l ow-se l f esteem as a r isk factor (e.g. G u a l , et a l . , 2002; M u s s e l l , B i n f o r d & Fulkerson , 2000). M u s s e l l , B i n f o r d and Fu lke r son (2000) also suggest that negative self-evaluation and perceived ineffectiveness are also r i sk factors. T h e f indings f rom this study relate to this area i n two ways. Firs t , the sub-theme Worthlessness , L o w - E s t e e m , and C r i t i c a l o f S e l f c lear ly illustrates the part icipants ' emot ional pa in , their negative feelings about themselves, and devaluat ion o f their o w n wor th . Secondly , w i t h i n the theme C o n t r o l and Rest r ic t ion , participants describe de r iv ing feelings o f satisfaction, power , and superiori ty f rom their personal quest for control associated w i t h their eating disorder. F r o m this perspective, the experience o f an eating disorder m a y be seen as a means through w h i c h the young w o m e n compensate for l o w self-esteem and negative self-concept. Per fec t ion ism is the most consistently ment ioned factor associated w i t h both eat ing disorders and giftedness. T h e literature rev iewed consistently cites perfectionist ic tendencies or perfect ionism as a r isk or personality factor among indiv iduals w h o experience eating disorders (e.g. A s h b y & Rot tman , 1998; Bas t ian i , R a o , W e l t z i n , & K a y e , 1995; G u a l , et a l . , 143 2002; M c V e y , Peplar , D a v i s , Flett , & A b d o l e l l , 2002; Shafran & M a n s e l l , 2001) . W i t h i n gifted literature a controversy exists as to whether perfect ionism among gifted ind iv idua l s contributes to maladjustment. F e w theorists disagree that perfect ionism is often a characteristic o f gifted ind iv idua ls (e.g. Greenspan, 2000; Nugent , 2000; Schuler , 2000; S i l v e r m a n ; 1999). Per fec t ion ism was a salient theme that emerged f rom the data. T h e theme, Per fec t ionism- S t r i v i ng to A t t a i n "Perfect" and the sub-themes, G o a l o f Perfect A n o r e x i a , Expecta t ions , and Determinat ion and Focus a l l relate to the part icipants ' experience o f perfect ionism as an aspect o f their eating disorder. Perfec t ionism was conceptual ized as fuel ing the eating disorder, and was also related to giftedness by several o f the participants. Per fec t ionism extended to want ing to be the best at having an eating disorder and to a determination to engage i n the eating disorder and restriction o f their intake "perfect ly". M u s s e l l , B i n f o r d and Fu lke r son (2000) also cite the use o f eating disorders to cope w i t h feelings o f inadequacy, and negative emotional i ty as r isk factors for eat ing disorders. C o p i n g w i t h feelings o f inadequacy may relate to the Worthlessness, L o w - S e l f Es t eem and C r i t i c a l o f S e l f sub-theme m u c h i n the same way as l o w self-esteem variables c i ted i n the gifted and eating disorder literature, but may also relate to the C o p i n g Through E n g a g i n g i n the Ea t i ng Diso rde r Theme . U s i n g a quali tat ive approach, W i c k s t e e d (2002) explored issues related to cont ro l among those w h o experience eating disorders. She suggested that al though control appears to be a prevalent theme that has been identif ied anecdotally, current literature often fai ls to address this topic. The personal quest for control , feel ing control led, be ing cont ro l led b y the 144 eating disorder itself, and controlling and restricting intake, emotions and experience, is substantiated in the Control and Restriction theme. Interesting and Unexpected Characteristics of the Data and Participants Based on my clinical experience in the eating disorder field, and a review of the literature, the findings included two very unexpected and interesting characteristics. I make no claims about the basis for these characteristics, as my thoughts have little evidence aside from my clinical intuition. Regardless, these points are curious and if nothing else speak to the homogeneity of the participant sample. First, although the selection criteria for participants did not specify what type of eating disorder the participants experienced, all participants described Anorexia Nervosa, which seemed to be exclusively the restricting type. I did not discriminate or select these participants based on this characteristic, nor did I know what kind of eating disorder they had experienced prior to the interview. M y clinical experience, and anecdotal evidence from other eating disorder professionals seems to indicate that adolescents who experience Anorexia Nervosa often also experience symptoms of Bul imia Nervosa, or the bingeing and purging type of Anorexia Nervosa, at some point in their recovery or eating disorder experience. Based on their own description, it seems that none of the participants varied in their eating disorder presentation. While this could be attributed to a lack of detail in describing specific eating or bingeing and purging behaviours, all participants spoke only of the restricting type of Anorexia Nervosa throughout their description of their eating disorder experience. 145 Secondly , the fact that the majority o f the participants experienced s ignif icant phys ica l deterioration, to the point o f requir ing hospi ta l izat ion, seemed a par t icular ly interesting point . A l t h o u g h statistics for the proport ion o f eating disorders requi r ing hospital izat ions are not available, i n m y experience few clients w h o experience eat ing disorders phys i ca l ly deteriorate to the point o f requir ing hospi ta l izat ion. A l l participants had received emergency med ica l interventions as a result o f their eating disorder and f ive o f the s ix were hospi ta l ized on one or more occas ion for a significant length o f t ime, due to be ing med ica l l y compromised or at a significant health r isk because o f their eating disorder. Th rough a br ie f f o l l ow-up conversat ion wi th the participant who was not hosp i ta l ized i n order to validate the situated structure, it has come to m y attention that she too is be ing asked to consider inpatient hospital treatment at this t ime. Implication of the Study and Findings Exploration of Original Research Contributions T h e f indings o f the current study overlap somewhat w i th factors that have been ment ioned i n previous literature specific to gifted adolescents w h o experience eating disorders. Previous theoretical explorat ion o f this topic has specif ied a number o f r i sk factors or c o m m o n characteristics among gifted indiv iduals w h o experience eating disorders, al though the depth o f their experience and its qualitative characteristics have been neglected. T h e richness and depth o f the current f indings add a unique and substantial l eve l o f mean ing to our understanding o f eating disorders, p rov id ing a broad basis for further explora t ion and c l i n i c a l applicat ions. 146 T h e themes that emerged through this study, and those that were ment ioned i n previous literature, can be addressed p r imar i ly through the themes o f Per fec t ion ism, L o w Sel f -Es teem, and Pr ior i t i za t ion o f the Needs o f Others. Heightened Awareness /Sens i t iv i ty , a sub-theme o f the Exper ience o f Giftedness and Ea t i ng Disorders E x p l i c i t l y Connec ted theme, is indi rec t ly referred to i n some way through the previous literature. C o p i n g through E n g a g i n g i n the Ea t i ng Disorder , W i t h d r a w a l and Isolation, and N o t F i t t i ng , are ment ioned but not elaborated on through previous examinations o f this topic. T h i s study offers several o r ig ina l research contributions, as many o f the themes have not been addressed i n previous literature. T h e l eve l o f depth at w h i c h the experience o f an eating disorder is descr ibed also contributes substantially to s imi la r themes identif ied in previous explorat ions o f this topic. T h e profound sense o f emot ional pain , self-devaluation, inner tu rmoi l , and progressive worsen ing o f the struggle w h i c h overwhelms the young w o m e n as they experience an eating disorder reflected i n themes such as. Nega t ive Affec t , Nega t ive Self-Perceptions, E m o t i o n a l Pa in , and Deter iorat ion and O v e r w h e l m e d and Conf l i c t ed , has not been captured previous ly . The quali ty o f these feelings cannot be described easi ly, al though they are central to understanding the experience o f an eating disorder. These aspects o f the eating disorder experience should be a focus o f c l i n i c a l interventions. T h e emot ional struggle and pa in associated wi th disordered eating requires support and understanding, and can be captured more fu l ly through the qualitative descript ion o f such themes. T h e theme, N o t F i t t ing : Incongruence and Awareness o f Differences is ment ioned by other theorists (e.g. Jackson & Peterson, 2003), yet cop ing wi th this element o f experience through an eating disorder has not been explored. Th i s theme has part icular relevance for examin ing the feelings and emotional pain o f gifted adolescents, and for evaluat ing the 147 potential r i sk o f maladapt ive cop ing mechanisms, such as an eating disorder that m a y result f rom incongruence i n their environment, unmet needs, and awareness o f differences among others. T h e part icipants ' awareness o f a sense o f being different f rom others w h o also experience an eating disorder has theoretical and c l i n i c a l impl ica t ions . T h e theme, C o p i n g through E n g a g i n g i n an Ea t i ng Disorder , has been br ief ly discussed prev ious ly but the profound sense o f pa in experienced i n this process, and the ident i f icat ion o f restrict ion o f intake as a solut ion to that struggle has not been exp lored as fu l ly as it is here. The expl ic i t relationship between giftedness and the experience o f an eating disorder, subject ively experienced by the participants, is also an o r ig ina l research contr ibut ion. T h e theme Exper ience o f Giftedness and Ea t ing Diso rde r and/or Struggle E x p l i c i t l y Connec ted captures the way i n w h i c h the young w o m e n identify their giftedness, and the characteristics or contr ibut ing factors associated wi th it that e x p l i c i t l y relate to their experience o f A n o r e x i a . The sub-theme Heightened Awareness /Sens i t iv i ty resonates w i t h m u c h o f the current literature on the socia l and emot ional qualit ies o f gifted adolescents, al though this study presents more c lear ly h o w such heightened awareness may present y o u n g ind iv idua l s w i t h challenges o f feel ing the "weight o f the w o r l d " and the emot iona l tone o f their environment . Per fec t ion ism is certainly not a new concept i n either eating disorder or gifted research, yet the unique way in w h i c h the participants articulate the l i v e d experience o f perfect ionism, h o w it is related to their eating disorder, giftedness, and the expectations o f themselves or others is o f interest and a unique contr ibut ion. H o w it feels to be consumed b y perfectionist ic needs or the quest to achieve "Perfect A n o r e x i a " should be exp lored further among gifted ind iv idua l s . 148 The theme Control and Restriction as it relates to the eating disorder experience is in many ways inevitable, as restriction of intake is a requisite behaviour for the diagnosis of Anorexia Nervosa. The idea of restriction is not new to the eating disorder literature, although the level of depth at which it is currently examined is unique. This study presents the theme of Control and Restriction as it relates to behavioural, emotional, and experiential elements of an eating disorder experience, and explores how restriction of intake is metaphorical for restriction of other aspects of the lives and experiences of the young women. A s Wicksteed (2002) suggested, the theme of control as it applies to the experience of an eating disorder is often referred to anecdotally, but has not been substantiated or explored through research literature. The theme, Control and Restriction, was prevalent throughout the experience of Anorexia for all the participants and was as a primary need fulfilled through their eating disorder experience. The converse side of control, and the irony of becoming controlled by the eating disorder, the means through which control was sought, is discussed. The need to please others is mentioned in previous eating disorder literature and may relate to the current study's sub-theme, Prioritization of the Needs of Others, yet there seems to be a qualitative difference in the way this sub-theme has been mentioned previously. Prioritizing the needs of others is less about pleasing others, than it is about sacrifice of personal needs, or sacrifice for a greater purpose as described in the theme, Sacrifice, Defiance, and Separation. This theme reveals elements of the experience of an eating disorder that go well beyond a need for validation or to please others. The conceptualization of Anorexia as an act of defiance is articulated by the participants and may be a point of significant clinical relevance. 149 A l t h o u g h phys i ca l deterioration and the associated emot ional and cogni t ive deterioration that m a y accompany A n o r e x i a is not a unique f ind ing , the severity o f med ica l r i sk and hospi ta l izat ion that was consistently described by the participants seems unique. Whether or not the severity o f the eating disorder experience is more profound among this popula t ion is o f interest and warrants invest igation. One o f the most interesting f indings o f this study was the theme Awareness o f Mul t i f ace ted U n d e r l y i n g Factors and the sub-theme, Exper ience o f E a t i n g D i so rde r as N o t A b o u t F o o d . It seems a c o m m o n perception that the search for thinness or phys ica l ideals is a p r imary mot iva t ion for disordered eating among adolescents. T h e s tudy's participants referred to an understanding o f the complex i ty o f the under ly ing dynamics that contribute to their eating disorder. T h i s factor alone may not be unique, but the overt reference to be ing distressed by their thinness, or exp l i c i t l y denying thinness as a goal , does not appear to be articulated or explored i n current eating disorder literature. T h i s theme may also represent a unique characteristic among this populat ion that warrants explorat ion, both c l i n i c a l l y and through further research. H o w the experience o f an eating disorder relates to identi ty or m a y represent a means through w h i c h to sever or distance the mind-body connect ion also warrants further explorat ion. The ways in w h i c h these young w o m e n attempt to separate their eating disorder f rom their sense o f self, in order to fight against it, is also o f interest. Identity and external izat ion o f the eating disorder are addressed i n the sub-themes, D e f i n i n g o f S e l f and Identity Issues and Exper ience o f Ea t ing Disorder Vo ice -Ex t e rna l i z a t i on o f Ea t i ng Disorder . F e w w o u l d argue that the experience o f an eating disorder brings pa in and suffering to those w h o l i ve the experience. G lo r i f i ca t ion o f the eating disorder experience must be 150 avoided but the theme, Purposeful , Apprec ia ted and M e a n i n g f u l Exper ience , illustrates the way i n w h i c h the participants consistently referred to the meaning and purpose o f their experience and the posi t ive aspects that it has brought to their awareness and l ives . T h e not ion o f a necessary struggle, or struggle for a greater purpose also warrants further explora t ion as it relates to gifted populations. T h e participants ' clear sense and understanding o f meaning and conceptul isat ion o f the eating disorder as a metaphor for other aspects o f their existence is s t r ik ing and further explorat ion or c l i n i c a l appl ica t ion o f that theme has significant importance. M a n y o f the f indings o f the current study elaborate on and describe i n r i ch detail the l i v e d experience o f p rev ious ly acknowledged factors associated w i t h eating disorders. Other themes that emerged f rom the data are uncharted areas that contribute a s ignif icant amount o f knowledge to the current state o f eating disorder knowledge as w e l l as gifted literature. T h e ways i n w h i c h these unique contr ibut ion cou ld be appl ied to c l i n i c a l settings and further explored through research are substantial. Implications For Psychotherapy, Psychoeducation, and Eating Disorder Treatment T h e quali tat ive data and in-depth descriptions o f the l i v e d experience o f an eating disorder offer m u c h more than a list o f personality traits or r isks factors t yp i ca l ly presented i n current literature. T h e results o f this study a l low those who choose to read and engage i n the f indings to gain a closer p rox imi ty to the actual experience o f an eating disorder among gifted adolescents. In do ing so, a g l impse into the subjective exper ienc ing o f those w h o experience the struggle is provided , and it is through that perspective that psychotherapeutic interventions and psychoeducat ion are most l i k e l y to have an impact . 151 M u c h o f the reasoning behind this study, and the impetus to pursue it, were based on a desire to contribute knowledge to prev ious ly neglected area, w h i c h c o u l d then be transferred to c l i n i c a l , and psychoeducat ional settings. A s a c l i n i c i an , and someone w h o h igh ly regards the scientist-practitioner mode l , the practical appl icat ion o f research f indings was a p r imary focus. A s the results o f this study relate to gifted adolescents, their c l i n i c a l u t i l i ty w i l l be p r imary related to that populat ion. F o r c l in ic ians w o r k i n g w i t h gifted adolescents exper iencing eating disorders, hav ing gained further understanding o f research f ind ing w i l l p rov ide a basis for more effective explorat ion wi th the cl ient . B e i n g aware o f h o w the s tudy's f indings and themes may p lay out or underl ie certain thoughts or behaviours m a y provide insight into the gifted adolescent cl ient and a means through w h i c h a therapeutic connect ion can be made. C l i n i c i a n s incorporat ing the research f indings into their c l i n i c a l w o r k are encouraged to immerse themselves i n the data and rather than search for the w a y that their gifted adolescents clients may fit the data, instead take what m a y be o f use and ind iv idua l relevance and leave the rest behind. In do ing so, the subjective experience o f the cl ient may be i l lumina ted through commona l i ty w i t h the experience o f others w h o struggle w i t h an eating disorder, but va lued i n and o f itself. C l i n i c a l use o f the research findings may include either the general structure or the i nd iv idua l situated structures. Ind iv idua l participant stories, or the f ina l themes and sub-themes c o u l d be explored , i n their entirety, or i nd iv idua l ly selected based on the needs and eating disorder presentations o f a particular client. S i m p l y asking h o w specif ic themes relate to an i n d i v i d u a l ' s experience may be beneficial to explorat ion and deve lop ing a sense o f the cl ient . T h e ind iv idua l experiences o f the participants, or the c o m m o n themes m a y resonate 152 w i t h gifted adolescents w h o experience eating disorders, or w i th their parents. T h e results c o u l d also be incorporated into an eating disorder group session as prompts for explora t ion and discuss ion. T h e unique aspects o f the f indings may have part icular relevance to w o r k i n g w i t h gifted clients w h o experience eating disorders, as they represent themes that may be less c o m m o n l y examined and poss ib ly neglected. F o r example , ident i fying that gifted adolescents m a y not be focused on thinness, may be attempting to restrict their exper ienc ing i n the w o r l d , to cope w i t h (or restrict) their heightened awareness, that they m a y feel that their experience o f an eating disorder experience is vast ly different f r o m other young w o m e n , or misunders tood i n treatment settings are a l l areas o f inqui ry w h i c h are suggested b y the research f indings. If indeed the f indings reflect the young w o m e n ' s giftedness, then giftedness needs to be explored and nurtured i n psychotherapeutic relat ionships, and the f indings o f this study prov ide a basis to begin to do so. F r o m a psychoeducat ional perspective, the research f indings contribute m u c h i n the same manner as they w o u l d i n c l i n i c a l settings. Considera t ion o f the unique themes that are part o f the experience o f an eating disorder among gifted adolescents is warranted b y those w h o specia l ize i n either eating disorder treatment, or psychotherapy w i t h gifted ind iv idua l s . S u c h professionals may also extract possible r isk factors f rom the research f indings and apply them to preventative or screening considerations. Spec i f i ca l ly parents o f gifted gir ls or young w o m e n , and more generally, parents o f gifted chi ldren , may benefit f rom an awareness o f the themes and a closer examinat ion o f what the experience o f an eating disorder is rea l ly l i ke based on the subjective exper iencing o f those who have been there. 153 T h e f indings i n many ways reach beyond the experience o f A n o r e x i a to inc lude what it is l i k e to experience struggle as a gifted adolescent. Th i s has broad impl ica t ions for professionals, researchers and parents, as it applies to gifted adolescents more general ly. A s the participants exp l i c i t l y relate their giftedness to the emot ional pain and struggle i n their l ives , parents o f a l l gifted chi ldren may benefit f rom an understanding o f an example o f h o w psycho log ica l and gifted issues may manifest themselves i n maladaptive ways . S ince the research f ind ing in many ways were gained as a result o f the part icipants ' abi l i ty to self-reflect and articulate the experience o f an eating disorder so thoroughly, there may also be broader appl icat ion to general eating disorder populat ions. T h e themes that emerged m a y or may not apply to non-gifted populat ions, but the poss ib i l i ty shou ld not be over looked . Non-g i f t ed adolescents who experience eating disorders m a y also benefit f rom examina t ion o f several o f the themes. Implications for Future Research There are a m y r i a d o f questions that remain for me w h i c h i n v o l v e research questions related to eating disorders among gifted indiv iduals . I continue to have many questions about the broader picture o f eating disorder prevalence and manifestations among gifted populat ions, such as whether the prevalence o f this issue among gifted popula t ion is indeed a "serious concern" as suggested by Peterson (1998, p. 197), or whether wi thout appropriate support gifted adolescents w i l l be more prone to "anxiety states, depressive disorder, eating disorders, and obsess ive-compuls ive behaviors" as suggested by Jackson and Peterson (2003, p. 177). 154 There are also further questions that remain unanswered by the current study that c o u l d be subsequently explored, us ing various research methodologies . B y cons ider ing the results as they may apply to other psycho log ica l disorders experienced by gifted adolescents, the role o f the themes and h o w they relate to giftedness c o u l d also be examined more concretely. A comparat ive study to include non-gifted adolescents w h o experience eating disorders w o u l d also shed l ight on the current f indings and substantiate h o w spec i f ica l ly they relate to giftedness. U s i n g the current research f indings as a basis for a more specif ic inqu i ry among gifted adolescents w h o experience eating disorders c o u l d y i e l d more elaborate explora t ion and descript ion o f the current themes. T h e methodology used i n this study p rov ided in-depth access to the experience o f an eating disorder, but was l i m i t i n g i n its u t i l i ty to question direct ly. H o w e v e r , this a l l o w e d for a weal th o f informat ion and r ich descriptions, w h i c h c o u l d be further explored us ing the themes as a starting place to fo rm subsequent research questions such as: H o w does giftedness relate to the experience o f the eating disorders? W h a t parts o f giftedness needed to be addressed i n eating disorder treatment and recovery among this populat ion? H o w does heightened sensit ivi ty or awareness relate to the need to cope through an eating disorder? Al te rna t ive methodology that a l lows for more structured quest ioning c o u l d extract more specific results and add to the depth o f the current f indings. T h e perspective o f the professional eating disorder commun i ty on this topic , or response to research f indings m a y also warrant invest igat ion, as the response f rom professionals through the recruitment process appeared m i x e d . Several professionals expressed intense enthusiasm for explorat ion o f this topic , w h i l e others were not clear as to h o w giftedness m a y p lay a role i n eating disorders. Feedback f rom gifted w o m e n w h o 155 continue to struggle with eating disorders, or who have recovered may also shed light on the relevance of the finding. Follow-up with the participants in the future to reflect on the themes of their experience, or to explore the current state of their psychological state or functioning may also be of interest. Strengths and Limitations of the Methodology and Study None of the previous literature related specifically to eating disorders among gifted adolescents has been based on empirical research findings, but was instead theoretical in nature, or based on clinical observation. The current study employed rigorous research methodology, and the findings have been validated through participants' feedback and various other means. The depth and breadth of the information gained through this study should add another, valuable dimension to our knowledge of eating disorders among gifted adolescents. Phenomenological interviewing and analysis provided the opportunity to explore the essence of the lived experience of the participants rather than a detached list of characteristics or risk factors. This provides a much clearer sense of what the young women struggling with an eating disorder experience live through and feel, and the meaning of that experience in their lives. It is also important to be mindful of the fact that these women are embedded in a social context and culture that may directly relate to their interpretation of their experiences. The lens of the researcher, through which the data was interpreted, was also susceptible to such influences. The most substantial limitation of this study is the need to consider whether the findings relate to the giftedness of the participants or their advanced abilities to articulate 156 their experience. Whether the f indings w i l l generalize to other gifted adolescents is also o f concern. T h i s l imi ta t ion is a consideration to be mindfu l of, and warrants further explora t ion but does not negate the f indings. L i m i t e d in terview contact w i th the participants is also an important point to consider for two reasons. Firs t , the necessary rapport that may have been a requisite for the participants to share their story may not have been established fu l ly . T h e r i c h and detai led interviews offer evidence to the contrary, but it is u n k n o w n whether a different l eve l o f depth or exper ienc ing may have emerged wi th greater rapport or fami l ia r i ty . Second ly , the s ingle in terview m a y have l im i t ed the amount o f details or the elaboration o f themes that m a y have been gained through several interviews wi th participants. A g a i n , the richness o f the data is to be considered based on the interview format used. A f ina l considerat ion relates to whether the f indings are specif ic to the experience o f an eating disorder, or more to the experience o f be ing a young gifted w o m a n w h o experiences an eating disorder. C la r i f i ca t ion o f this point invo lves cons ider ing that w h e n prompted to tel l the story o f their eating disorder, the young w o m e n natural ly exp lored the surrounding issues, contr ibut ing factors, related emotional states and meaning o f their experience. T h e f indings do not provide details o f the da i ly behavioural or cogni t ive aspects o f the eating disorder. Second order reflection, and the themes that were der ived f rom those reflections, fo rm the basis o f these research f indings. B y focusing on this l eve l o f ref lect ion, the leve l o f depth and complex i ty at w h i c h the young w o m e n experience their eating disorder was honoured. T h e f indings represent the participants ' subjective experience o f an eat ing disorder, a pr ior i ty o f this research endeavor. 157 Researcher's Subjective Experience Conduc t ing this study has been an extraordinary experience, one that has taken a significant amount o f t ime, attention, and a steadfast be l ief i n its value. A s I reflect on m y journey through this research project, I have a sense that this is a beg inn ing rather than an end point . If nothing else, the things that I have learned, and the ways that I have g r o w n as a person and a researcher through this, w i l l remain w i t h me. M a n y relat ionships and interactions wi th others make strong impressions on you . B e i n g immersed i n the experiences o f these young w o m e n , at the leve l required to get to this stage, a l l owed me to interact w i t h their stories o f A n o r e x i a i n a very unique way . I value m y humanness, embrace fa l l ib i l i ty , and fu l ly admit that I interpret the experience o f others and m y environment through m y o w n beliefs and experiences. I do not th ink this is a fault i n a qualitative researcher, s imp ly an important element to be mind fu l o f and to never fa i l to consider. I chal lenged m y s e l f to do so i n a way that I have not done previous ly , and am the first to admit I am not perfect. One o f the most cha l leng ing tasks o f this research was to a l l ow myse l f to use a l l m y most effective interpersonal, counse l l ing and communica t ion sk i l l s , but at this same time reflect carefully back on m y humanness and beliefs and h o w they affected each stage o f the project. Th i s reflective practice takes a tremendous amount o f energy and at t imes was terr ifying. M y natural state o f interest and connect iv i ty w i t h others has typ ica l ly led me to gain a fa i r ly accurate understanding o f people and relationships. Throughout the research process, I often caught m y s e l f w i s h i n g I d i d not possess such insight, w h i c h w o u l d have made the bracket ing and declarat ion o f biases and assumptions mush less onerous. I was keenly aware o f the poss ib i l i ty o f on ly f i nd ing i n the data o n l y what I thought may emerge. I think that this a l l owed me to be more honest, 158 r igorous, and cha l lenging towards myself . I d i d f ind things that I expected to, but I was also pleased to be educated and perplexed by what also emerged f rom the data. W o r d s are inadequate to describe m y experience o f hav ing these young w o m e n share their story, pa in , and t r iumphs related to a very personal part o f their l ives w i t h me. W o r k i n g w i t h adolescents w h o experience eating disorders is not new to me. I a m accustomed to b u i l d i n g rapport w i th these young women , the challenges that this area o f practice br ings , and the devastating impact that eating disorders often have. The courage to take one step c loser to be ing free f rom their eating disorder and sharing their pa in and struggle i n the hopes that they m a y be heard and supported is a r isk for young people engaging i n treatment. Often, f o l l o w i n g a therapy session wi th a young w o m a n w h o experiences an eating disorder I reflect back on the intensity and power o f the therapeutic interaction. M u c h i n that same way , I sat w i t h these young w o m e n w h o came forward not to be treated or w i t h the specif ic agenda o f w o r k i n g toward their recovery, but to assist i n a project that they felt was important, and to share their story i n the hopes that it may be heard and help someone else. 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Refusal to mainta in body weight at or above a m i n i m a l l y normal weight for age and height. B . Intense fear o f ga in ing weight or becoming fat, even though underweight . C . Disturbances i n the way in w h i c h one's body weight or shape is experienced, undue influence o f body weight or shape on self-evaluation, or denial o f the seriousness o f the current l o w body weight. D . In postmenarcheal females, amenorrhea, i.e. the absence o f at least three consecut ive menstrual cycles . Specific type: Restricting Type: dur ing the current episode o f A n o r e x i a Nervosa , the person has not regular ly engaged i n binge-eating or purg ing behaviour (i.e. self- induced v o m i t i n g , or the misuse o f laxatives, diuretics or enemas) Binge/Eating Purging type: dur ing the current episode o f A n o r e x i a Ne rvosa , the person has regular ly engaged i n binge-eating or purging behaviour (i.e. se l f - induced v o m i t i n g , or the misuse o f laxatives, diuretics or enemas) Diagnostic Criteria for 307.51 Bulimia Nervosa A . Recurrent episodes o f binge eating. A n episode o f binge eating is character ized by the f o l l o w i n g : 1) eating, i n a discrete periods o f t ime (e.g. w i th in any 2 hour per iod) , an amount o f food that is defini tely larger than most people w o u l d eat dur ing a s imi la r per iod o f t ime and under s imi la r circumstances. 2) a sense o f lack o f control over eating dur ing that episode (i.e. fee l ing that one cannot stop eating or control what or how m u c h one is eating.) B . Recurrent inappropriate compensatory behavior i n order to prevent weight gain, such as self- induced vomi t i ng ; misuse o f laxatives, diuretics, enemas or other medicat ions; fasting; or excessive exercise 170 C . The binge eating and inappropriate compensatory behavior both occur , on average, at least twice per week for 3 months. D . S e l f evaluat ion is unduly inf luenced by body shape and weight . E . T h e disturbance does not occur exc lus ive ly dur ing episodes o f A n o r e x i a N e r v o s a Specific types: Purging type: dur ing the current episode o f B u l i m i a Nervosa , the person has regular ly engaged i n self- induced v o m i t i n g or the misuse o f laxat ive, diuretics, or enemas Non-Purging type: dur ing the current episode o f B u l i m i a Ne rvosa , the person has used inappropriate compensatory behavior such as fasting or excessive exercise, but has not regular ly engaged i n self- induced vomi t i ng or the misuse o f laxat ive, diuretics, or enema 307.50 Eating Disorder Not Otherwise Specified T h e Ea t i ng Diso rde r N o t Otherwise Spec i f ied category is for disorders o f eating that do not meet the cr i ter ia for any specific eating disorder. E x a m p l e s include: 1. F o r females, a l l the cr i ter ia for A n o r e x i a N e r v o s a are met except that the ind iv idua l has regular menses. 2. A l l the cri teria for A n o r e x i a N e r v o s a are met except that, despite significant weight loss the ind iv idua l ' s current weight is i n the normal range. 3. A l l the cri ter ia for B u l i m i a N e r v o s a are met except that the binge eating and inappropriate compensatory mechanisms occur at a frequency o f less than twice per week or for a durat ion o f less than 3 months. 4. The regular use o f inappropriate compensatory behaviors by an ind iv idua l o f normal body weight after eating sma l l amounts o f food (e.g. self- induced vomi t i ng after the consumpt ion o f two cookies) . 5. Repeatedly chewing and spitt ing out, but not s w a l l o w i n g , large amounts o f food. 171 Appendix B Interview Protocol and Example Interview Questions Project: A Phenomenological Inquiry of the Experience of Disordered Eating Among Gifted Female Adolescents. To be read to participant: The purpose of this qualitative study wi l l be to provide an in-depth description of the lived experience, common themes and meaning of disordered eating among gifted adolescents. A phenomenological study using in-depth interviews wi l l allow me (the student researcher) to better understand and describe the perceptions and experience of the participants and look for the meaning you ascribe to this phenomenon. These data wi l l be used to explore and describe your lived experience and the lived experience of other participants. It is important for you to know that recounting your experience of disordered eating and the associated emotions may be difficult and should you need to stop or take a break at any time please do not hesitate to do so. Sample Interview Questions: • Can you share with me the story of your experience with disordered eating? • Can you think back to a time before you experienced disordered eating and take me through that time to the present? • Can you run through what a typical day was like for you? • Prior to experiencing disordered eating what was going on in your life and for you as a young woman? • What is the meaning and emotions related to the experience of disordered which you are describing? • Is there anything else that you want to add to help me understand your experience? 1 7 2 Participants w i l l be encouraged to articulate their experience in relation to felt time, relationship, space and body (i.e. to their environment at home, at school, with friends and family). Possible prompts for further exploration: • .... sounds important to you. Can you tell me more about that? • What is the meaning of that for you? What were/are the emotions and feelings related to the experience you are describing? • Can you give me an example of... ? • Y o u haven't talked much about... .can you tell me how that fits into your experience? • I seem to see a link between.. .and .... H o w does that fit your experience? • Can you describe for me the meaning associated with the topic you are discussing? After completion of the interview some time wi l l be taken to debrief the participant about how they are feeling after having shared their experience. (Thank individual for participating in the interview. Assurance of confidentiality of responses and scheduling of future interview.) 176 Appendix F Adolescent Subject Consent/Assent Form Title of Study: A Phenomenological Inquiry of the Experience of Disordered Eating Among Gifted Female Adolescents Alison Bell, a Mas te r ' s l eve l graduate student i n the department o f C o u n s e l l i n g P s y c h o l o g y at the U n i v e r s i t y o f B r i t i s h C o l u m b i a , is undertaking this project as research for a graduate thesis. P r i n c i p a l Investigator: R i c h a r d Y o u n g E D . D . Department o f Educa t iona l , C o u n s e l l i n g P s y c h o l o g y and Spec ia l Educa t ion , The Un ive r s i t y o f B r i t i s h C o l u m b i a . T h e purpose o f this study is to provide an in-depth explorat ion and descr ipt ion o f the c o m m o n themes o f the experience o f disordered eating among gifted female adolescents (ages 15-18). Y o u have been asked to participate i n this study based on your self-ident i f icat ion as f i t t ing the advertised cri ter ia or by responding to a letter o f contact g iven to y o u b y a th i rd party. In do ing so y o u have identif ied yoursel f as an i nd iv idua l w h o as an adolescent (age 15-18) experiences/experienced disordered eating and have been c lass i f ied as gifted through part ic ipat ion i n a gifted program at school , assessment f rom a professional w i t h expertise i n gifted psychotherapy, or I Q testing w h i c h y ie lded results o f 130 or above. L e g a l l y y o u are considered a mino r wh i l e under the age o f 19. F o r this reason a parent/legal guardian must also provide consent for your part icipat ion i n this study. Because it is reasonable to assume that y o u are able to understand and make decisions about y o u o w n part ic ipat ion y o u must also provide assent to participate. B y p rov id ing assent this means that y o u agree wi th the decis ion o f your parent/guardian to provide consent for par t ic ipat ion. T h e study w i l l i nvo lve approximately 6-10 participants w h o w i l l engage i n an in-depth in terview to share their experience o f disordered eating wi th A l i s o n B e l l . I f y o u agree to participate the in i t i a l in terview w i l l last approximately 1-2 hours. Af t e r the in terview has been transcribed an addi t ional interview, approximately 1 hour i n length, w i l l be scheduled to go over the transcript w i t h y o u to ensure its accuracy and so that y o u m a y have the opportunity to add any further information you w i s h . A l l interviews w i l l be audio recorded. Y o u r identi ty and par t ic ipat ion w i l l be kept strictly confident ia l . O n l y A l i s o n B e l l and D r . R i c h a r d Y o u n g w i l l have access to your ident i fying informat ion. A l l in terview transcripts and audio-recorded interviews w i l l be identif ied on ly by a code number and kept i n a l o c k e d f i l i n g cabinet. A n y other ind iv iduals i nvo lved i n the data analysis or t ranscript ion o f data w i l l on ly identify data f r o m your in terview by code number. Y o u w i l l not be ident i f ied by name i n any reports or presentations o f the completed study. D a t a stored on computer files w i l l be accessed on ly through secured passwords and stored w i t h no ident i fy ing informat ion . Consent forms w i l l be stored i n a secured f i l i n g cabinet separate f rom any data col lected. 178 Appendix G Subject Consent Form Title of Study: A Phenomenological Inquiry of the Experience of Disordered Eating Among Gifted Female Adolescents Alison Bell, a Mas te r ' s l eve l graduate student i n the department o f C o u n s e l l i n g P s y c h o l o g y at the U n i v e r s i t y o f B r i t i s h C o l u m b i a , is undertaking this project as research for a graduate thesis. P r i n c i p a l Investigator: R i c h a r d Y o u n g E D . D . Department o f Educa t iona l , C o u n s e l l i n g P s y c h o l o g y and Spec ia l Educa t ion , The Un ive r s i t y o f B r i t i s h C o l u m b i a . The purpose o f this study is to provide an in-depth explorat ion and descr ipt ion o f the c o m m o n themes o f the experience o f disordered eating among gifted female adolescents (ages 15-18). Y o u have been asked to participate i n this study based on your self -ident i f icat ion as f i t t ing the advertised cri teria or by responding to a letter o f contact g iven to y o u by a third party. In do ing so y o u have identif ied yourse l f as an i nd iv idua l w h o as an adolescent (age 15-18) experiences/experienced disordered eating and have been c lass i f ied as gifted through part ic ipat ion i n a gifted program at school , assessment f rom a professional w i t h expertise i n gifted psychotherapy, or I Q testing w h i c h y ie lded results o f 130 or above. The study w i l l i n v o l v e approximately 6-10 participants who w i l l engage i n an in-depth in terview to share their experience o f disordered eating wi th A l i s o n B e l l . I f y o u agree to participate the in i t i a l in terview w i l l last approximately 1-2 hours. Af t e r the in terv iew has been transcribed an addi t ional interview, approximately 1 hour i n length, w i l l be scheduled to go over the transcript w i th y o u to ensure its accuracy and so that y o u m a y have the opportunity to add any further information you w i s h . A l l interviews w i l l be audio recorded. Y o u r identity and part icipat ion w i l l be kept strictly confident ia l . O n l y A l i s o n B e l l and D r . R i c h a r d Y o u n g w i l l have access to your ident i fying information. A l l in terview transcripts and audio-recorded interviews w i l l be identif ied on ly by a code number and kept i n a l o c k e d f i l i n g cabinet. A n y other ind iv iduals i n v o l v e d i n the data analysis or t ranscript ion o f data w i l l o n l y identify data f rom your interview by code number. Y o u w i l l not be ident i f ied b y name i n any reports or presentations o f the completed study. D a t a stored on computer fi les w i l l be accessed on ly through secured passwords and stored wi th no ident i fy ing informat ion . Consent forms w i l l be stored i n a secured f i l i ng cabinet separate f rom any data col lec ted . Y o u w i l l receive a smal l gift, w i th an approximate value o f $15 should y o u agree to participate i n this study. Shar ing the experience o f disordered eating may be an emotional experience for you . S h o u l d y o u experience psycho log ica l distress and are currently rece iv ing treatment or psychotherapy 180 Appendix H Parental Consent Form Title of Study: A Phenomenological Inquiry of the Experience of Disordered Eating Among Gifted Female Adolescents Alison Bell, a Mas te r ' s l eve l graduate student in the department o f C o u n s e l l i n g P s y c h o l o g y at the U n i v e r s i t y o f B r i t i s h C o l u m b i a , is undertaking this project as research for a graduate thesis. P r i n c i p a l Investigator: R i c h a r d Y o u n g E D . D . Department o f Educa t iona l , C o u n s e l l i n g P s y c h o l o g y and Spec ia l Educa t ion , The Un ive r s i t y o f B r i t i s h C o l u m b i a . T h e purpose o f this study is to provide an in-depth explorat ion and descr ipt ion o f the c o m m o n themes o f the experience o f disordered eating among gifted female adolescents (ages 15-18). Y o u r daughter or the mino r for w h o m you are the legal guardian has been asked to participate i n this study based on self-identif ication as f i t t ing the advertised cr i ter ia or by responding to a letter o f contact g iven to her by a third party. In do ing so your daughter or the mino r for w h o m you are the legal guardian has ident i f ied herself as an i n d i v i d u a l w h o as an adolescent (age 15-18) experiences/experienced disordered eating and was c lass i f ied as gifted through part icipat ion in a gifted program at schoo l , assessment f rom a professional w i t h expertise i n gifted psychotherapy, or I Q testing w h i c h y i e lded results o f 130 or above. T h e study w i l l i nvo lve approximately 6-10 participants w h o w i l l engage i n an in-depth in terv iew to share their experience o f disordered eating wi th A l i s o n B e l l . Par t ic ipa t ion w i l l inc lude the in i t i a l in terview, w h i c h w i l l last approximately 1-2 hours. Af te r the in terv iew has been transcribed an addi t ional interview, approximately 1 hour in length, w i l l be scheduled to go over the transcript to ensure its accuracy and so that the participant m a y have the opportunity to add any further information she wishes. A l l interviews w i l l be audio recorded. Part icipant identity and part icipat ion w i l l be kept strictly confident ia l . O n l y A l i s o n B e l l and D r . R i c h a r d Y o u n g w i l l have access to ident i fy ing informat ion. A l l in terview transcripts and audio-recorded interviews w i l l be identif ied on ly by a code number and kept i n a l o c k e d f i l i n g cabinet. A n y other ind iv iduals i nvo lved i n the data analysis or t ranscript ion o f data w i l l o n l y identify data f r o m the interview(s) by code number. Participants w i l l not be ident i f ied by name i n any reports or presentations o f the completed study. D a t a stored on computer fi les w i l l be accessed on ly through secured passwords and stored w i t h no ident i fy ing informat ion. Consent forms w i l l be stored i n a secured f i l i n g cabinet separate f rom any data col lected. Part icipants w i l l receive a smal l gift, approximately $15, i n value should they participate i n this study. 

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